Sstr-targeted conjugates and particles and formulations thereof

ABSTRACT

Conjugates of an active agent such as DM1 attached to a targeting moiety, such as a somatostatin receptor binding moiety, via a linker, and particles comprising such conjugates have been designed. Such conjugates and particles can provide improved temporospatial delivery of the active agent, improved biodistribution and penetration in tumor, and/or decreased toxicity. Methods of making the conjugates, the particles, and the formulations thereof are provided. Methods of administering the formulations to a subject in need thereof are provided, for example, to treat or prevent cancer.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. Non-Provisional application Ser. No. 16/345,306, filed Apr. 26, 2019, entitled “SSTR-TARGETED CONJUGATES AND PARTICLES AND FORMULATIONS THEREOF,” which is 35 U.S.C. § 371 U.S. National Stage Entry of International Application No. PCT/US2017/058701 filed Oct. 27, 2017, entitled “SSTR-TARGETED CONJUGATES AND PARTICLES AND FORMULATIONS THEREOF,” which claims the benefit of priority of U.S. Provisional Patent Application No. 62/414,481, filed Oct. 28, 2016, entitled “SSTR-TARGETED CONJUGATES AND PARTICLES AND FORMULATIONS THEREOF,” the contents of each of which are herein incorporated by reference in their entirety.

FIELD OF THE INVENTION

The invention generally relates to the field of targeting ligands, conjugates thereof, and particles for drug delivery. More particularly, the invention relates to the use of molecules targeting somatostatin receptors, e.g., for treating cancer.

BACKGROUND OF THE INVENTION

Developments in nanomedicine are generally directed towards improving the pharmaceutical properties of the drugs and, in some cases, enhancing the targeted delivery in a more cell-specific manner. Several cell-specific drugs have been described, and include monoclonal antibodies, aptamers, peptides, and small molecules. Despite some of the potential advantages of such drugs, a number of problems have limited their clinical application, including size, stability, manufacturing cost, immunogenicity, poor pharmacokinetics and other factors.

Nanoparticulate drug delivery systems are attractive for systemic drug delivery because they may be able to prolong the half-life of a drug in circulation, reduce non-specific uptake of a drug, and improve accumulation of a drug at tumors, e.g., through an enhanced permeation and retention (EPR) effect. There are limited examples of therapeutics formulated for delivery as nanoparticles, which include DOXIL® (liposomal encapsulated doxyrubicin) and ABRAXANE® (albumin bound paclitaxel nanoparticles).

The development of nanotechnologies for effective delivery of drugs or drug candidates to specific diseased cells and tissues, e.g., to cancer cells, in specific organs or tissues, in a temporospatially regulated manner potentially can overcome or ameliorate therapeutic challenges, such as systemic toxicity. However, while targeting of the delivery system may preferentially deliver drug to a site where therapy is needed, the drug released from the nanoparticle may not for example, remain in the region of the targeted cells in efficacious amounts or may not remain in the circulation in a relatively non-toxic state for a sufficient amount of time to decrease the frequency of treatment or permit a lower amount of drug to be administered while still achieving a therapeutic effect. Antibody drug conjugates comprise an antibody and a cytotoxic payload have been designed. However, the size of antibodies limits solid tumor penetration compared to smaller targeting ligands (see Xiang et al., Theranostics, vol. 5(10):1083-1097 (2015), the contents of which are incorporated herein by reference in their entirety). Smaller targeting ligands also penetrate solid tumors faster, which is important for payloads that require a high tumor C_(max). Accordingly, there is a need in the art for improved drug targeting and delivery and to design drugs with deeper solid tumor penetration.

SUMMARY OF THE INVENTION

Applicants have created molecules that are conjugates of a somatostatin receptor binding moiety and an active agent, e.g., a cancer therapeutic agent such as a platinum-containing agent. Furthermore, such conjugates can be encapsulated into particles. The conjugates and particles are useful for delivering active agents such as tumor cytotoxic agents to cells expressing somatostatin receptors (SSTRs).

Applicants have developed novel conjugates and particles, including polymeric nanoparticles, and pharmaceutical formulations thereof. The conjugates of an active agent such as a therapeutic, prophylactic, or diagnostic agent are attached via a linker to a targeting moiety that can bind a somatostatin receptor. The conjugates and particles can provide improved temporospatial delivery of the active agent and/or improved biodistribution compared to delivery of the active agent alone. In some cases, the targeting moiety can also act as a therapeutic agent. In some embodiments, the targeting agent does not substantially interfere with efficacy of the therapeutic agent in vivo. Methods of making conjugates, particles, and formulations comprising such particles are described herein. Such particles are useful for treating or preventing diseases that are susceptible to the active agent, for example, treating or preventing cancer or infectious diseases.

The conjugates include a targeting ligand and an active agent connected by a linker, wherein the conjugate in some embodiments has the formula:

(X—Y−Z)

wherein X is a somatostatin receptor targeting moiety; Y is a linker; and Z is an active agent. In one embodiment, the active agent may be DM1.

In one aspect of the invention, a method of reducing proliferation, increasing apoptosis, or increasing arrest of cells is provided. The method comprises administering a conjugate to the cells, wherein the conjugate comprises an active agent coupled to a somatostatin receptor (SSTR) targeting moiety by a linker, wherein the active agent is mertansine (DM1).

In another aspect of the invention, a method of treating a tumor, reducing volume of a tumor or delivering DM1 to a tumor in a subject is provided. The method comprises administering a conjugate to the subject, wherein the conjugate comprises an active agent coupled to a somatostatin receptor (SSTR) targeting moiety by a linker, wherein the active agent is mertansine (DM1).

In yet another aspect of the invention, a method of treating neuroendocrine cancers is provided, wherein the neuroendocrine cancer is selected from small cell lung cancer (SCLC), pheochromocytoma, neuroblastoma, ganglioneuroma, paraganglioma, carcinoids, gastrinoma, glucagonoma, vasoactive intestinal polypeptide-secreting tumor, pancreatic polypeptide-secreting tumor, nonfunctioning gastroenteropancreatic tumors, meduallary thyroid cancer, Merkel cell tumor of the skin, pituitary adenoma, and pancreatic cancer. The method comprises administering a conjugate to the cells, wherein the conjugate comprises an active agent coupled to a somatostatin receptor (SSTR) targeting moiety by a linker, wherein the active agent is mertansine (DM1).

In yet another aspect of the invention, a pharmaceutical composition comprising a conjugate and an additional active agent is provided, wherein the conjugate comprises an active agent coupled to a somatostatin receptor (SSTR) targeting moiety by a linker, and wherein the active agent is mertansine (DM1).

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is the figure on the top right of page 340 of Dreher et al., JNCI, vol. 98(5):335 (2006).

FIG. 2A shows SSTR2 receptor internalization intensity. FIG. 2B shows SSTR2 internationalization in H524-MD tumor xenografts at different times. FIG. 2C shows levels of SSTR2 internalization distribution. FIG. 2D shows SSTR2 internal cellular distribution in H524 tumor xenografts at different times.

FIG. 3 shows TGI % of HCC-33 xenograft treated with Conjugate 57.

FIG. 4 shows in vitro evaluation of Conjugate 57 for hERG ion channel inhibition. Dashed line indicates the mean effect of vehicle control wells (0.3% DMSO).

FIG. 5 shows PK profiles of various formulations.

DETAILED DESCRIPTION OF THE INVENTION

At least five somatostatin receptors subtypes have been characterized, and tumors can express various receptor subtypes. (e.g., see Shaer et al., Int. 3. Cancer 70:530-537, 1997). Naturally occurring somatostatin and its analogs exhibit differential binding to receptor subtypes. Applicants have exploited this feature to create novel particles to improve targeting of a conjugate comprising an active agent to a disease tissue target. Such targeting can, for example, improve the amount of active agent at a site and decrease active agent toxicity to the subject. As used herein, “toxicity” refers to the capacity of a substance or composition to be harmful or poisonous to a cell, tissue organism or cellular environment. Low toxicity refers to a reduced capacity of a substance or composition to be harmful or poisonous to a cell, tissue organism or cellular environment. Such reduced or low toxicity may be relative to a standard measure, relative to a treatment or relative to the absence of a treatment.

Toxicity may further be measured relative to a subject's weight loss where weight loss over 15%, over 20% or over 30% of the body weight is indicative of toxicity. Other metrics of toxicity may also be measured such as patient presentation metrics including lethargy and general malaiase. Neutropenia or thrombopenia may also be metrics of toxicity.

Pharmacologic indicators of toxicity include elevated AST/ALT levels, neurotoxicity, kidney damage, GI damage and the like.

The conjugates are released after administration of the particles. The targeted drug conjugates utilize active molecular targeting in combination with enhanced permeability and retention effect (EPR) and improved overall biodistribution of the particles to provide greater efficacy and tolerability as compared to administration of targeted particles or encapsulated untargeted drug.

In addition, the toxicity of a conjugate containing a somatostatin targeting moiety linked to an active agent for cells that do not express SSTRs is predicted to be decreased compared to the toxicity of the active agent alone. Without committing to any particular theory, applicants believe that this feature is because the ability of the conjugated active agent to enter a cell is decreased compared the ability to enter a cell of the active agent alone. Accordingly, the conjugates comprising an active agent and particles containing the conjugates as described herein generally have decreased toxicity for non-SSTR expressing cells and at least the same or increased toxicity for SSTR expressing cells compared to the active agent alone.

It is an object of the invention to provide improved compounds, compositions, and formulations for temporospatial drug delivery.

It is further an object of the invention to provide methods of making improved compounds, compositions, and formulations for temporospatial drug delivery.

It is also an object of the invention to provide methods of administering the improved compounds, compositions, and formulations to individuals in need thereof.

I. Conjugates

Conjugates include an active agent or prodrug thereof attached to a targeting moiety, e.g., a molecule that can bind to an SSTR, by a linker. The conjugates can be a conjugate between a single active agent and a single targeting moiety, e.g., a conjugate having the structure X—Y—Z where X is the targeting moiety, Y is the linker, and Z is the active agent.

In some embodiments the conjugate contains more than one targeting moiety, more than one linker, more than one active agent, or any combination thereof. The conjugate can have any number of targeting moieties, linkers, and active agents. The conjugate can have the structure X—Y—Z—Y—X, (X—Y—Z—Y)_(n)—Z where X is a targeting moiety, Y is a linker, Z is an active agent, and n is an integer between 1 and 50, between 2 and 20, for example, between 1 and 5. Each occurrence of X, Y, and Z can be the same or different, e.g., the conjugate can contain more than one type of targeting moiety, more than one type of linker, and/or more than one type of active agent.

The conjugate can contain more than one targeting moiety attached to a single active agent. For example, the conjugate can include an active agent with multiple targeting moieties each attached via a different linker. The conjugate can have the structure X—Y—Z—Y—X where each X is a targeting moiety that may be the same or different, each Y is a linker that may be the same or different, and Z is the active agent.

The conjugate can contain more than one active agent attached to a single targeting moiety. For example the conjugate can include a targeting moiety with multiple active agents each attached via a different linker. The conjugate can have the structure Z—Y—X—Y—Z where X is the targeting moiety, each Y is a linker that may be the same or different, and each Z is an active agent that may be the same or different.

A. Active Agents

A conjugate as described herein contains at least one active agent (a first active agent). The conjugate can contain more than one active agent, that can be the same or different from the first active agent. The active agent can be a therapeutic, prophylactic, diagnostic, or nutritional agent. A variety of active agents are known in the art and may be used in the conjugates described herein. The active agent can be a protein or peptide, small molecule, nucleic acid or nucleic acid molecule, lipid, sugar, glycolipid, glycoprotein, lipoprotein, or combination thereof. In some embodiments, the active agent is an antigen, an adjuvant, radioactive, an imaging agent (e.g., a fluorescent moiety) or a polynucleotide. In some embodiments the active agent is an organometallic compound.

Anti-Cancer Agents

The active agent can be a cancer therapeutic. Cancer therapeutics include, for example, death receptor agonists such as the TNF-related apoptosis-inducing ligand (TRAIL) or Fas ligand or any ligand or antibody that binds or activates a death receptor or otherwise induces apoptosis. Suitable death receptors include, but are not limited to, TNFR1, Fas, DR3, DR4, DR5, DR6, LTβR and combinations thereof.

Cancer therapeutics such as chemotherapeutic agents, cytokines, chemokines, and radiation therapy agents can be used as active agents. Chemotherapeutic agents include, for example, alkylating agents, antimetabolites, anthracyclines, plant alkaloids, topoisomerase inhibitors, and other antitumor agents. Such agents typically affect cell division or DNA synthesis and function. Additional examples of therapeutics that can be used as active agents include monoclonal antibodies and the tyrosine kinase inhibitors e.g. imatinib mesylate, which directly targets a molecular abnormality in certain types of cancer (e.g., chronic myelogenous leukemia, gastrointestinal stromal tumors).

Chemotherapeutic agents include, but are not limited to cisplatin, carboplatin, oxaliplatin, mechlorethamine, cyclophosphamide, chlorambucil, vincristine, vinblastine, vinorelbine, vindesine, taxol and derivatives thereof, irinotecan, topotecan, amsacrine, etoposide, etoposide phosphate, teniposide, epipodophyllotoxins, trastuzumab, cetuximab, and rituximab, bevacizumab, and combinations thereof. Any of these may be used as an active agent in a conjugate.

In some embodiments, the active agent can be 20-epi-1,25 dihydroxyvitamin D3, 4-ipomeanol, 5-ethynyluracil, 9-dihydrotaxol, abiraterone, acivicin, aclarubicin, acodazole hydrochloride, acronine, acylfulvene, adecypenol, adozelesin, aldesleukin, all-tk antagonists, altretamine, ambamustine, ambomycin, ametantrone acetate, amidox, amifostine, aminoglutethimide, aminolevulinic acid, amrubicin, amsacrine, anagrelide, anastrozole, andrographolide, angiogenesis inhibitors, antagonist D, antagonist G, antarelix, anthramycin, anti-dorsalizing morphogenetic protein-1, antiestrogen, antineoplaston, antisense oligonucleotides, aphidicolin glycinate, apoptosis gene modulators, apoptosis regulators, apurinic acid, ARA-CDP-DL-PTBA, arginine deaminase, asparaginase, asperlin, asulacrine, atamestane, atrimustine, axinastatin 1, axinastatin 2, axinastatin 3, azacitidine, azasetron, azatoxin, azatyrosine, azetepa, azotomycin, baccatin III derivatives, balanol, batimastat, benzochlorins, benzodepa, benzoylstaurosporine, beta lactam derivatives, beta-alethine, betaclamycin B, betulinic acid, BFGF inhibitor, bicalutamide, bisantrene, bisantrene hydrochloride, bisaziridinylspermine, bisnafide, bisnafide dimesylate, bistratene A, bizelesin, bleomycin, bleomycin sulfate, BRC/ABL antagonists, breflate, brequinar sodium, bropirimine, budotitane, busulfan, buthionine sulfoximine, cabazitaxel, cactinomycin, calcipotriol, calphostin C, calusterone, camptothecin, camptothecin derivatives, canarypox IL-2, capecitabine, caracemide, carbetimer, carboplatin, carboxamide-amino-triazole, carboxyamidotriazole, carest M3, carmustine, earn 700, cartilage derived inhibitor, carubicin hydrochloride, carzelesin, casein kinase inhibitors, castano spermine, cecropin B, cedefingol, cetrorelix, chlorambucil, chlorins, chloroquinoxaline sulfonamide, cicaprost, cirolemycin, cisplatin, cis-porphyrin, cladribine, clomifene analogs, clotrimazole, collismycin A, collismycin B, combretastatin A4, combretastatin analog, conagenin, crambescidin 816, crisnatol, crisnatol mesylate, cryptophycin 8, cryptophycin A derivatives, curacin A, cyclopentanthraquinones, cyclophosphamide, cycloplatam, cypemycin, cytarabine, cytarabine ocfosfate, cytolytic factor, cytostatin, dacarbazine, dacliximab, dactinomycin, daunorubicin hydrochloride, decitabine, dehydrodidemnin B, deslorelin, dexifosfamide, dexormaplatin, dexrazoxane, dexverapamil, dezaguanine, dezaguanine mesylate, diaziquone, didemnin B, didox, diethylnorspermine, dihydro-5-azacytidine, dioxamycin, diphenyl spiromustine, docetaxel, docosanol, dolasetron, doxifluridine, doxorubicin, doxorubicin hydrochloride, droloxifene, droloxifene citrate, dromostanolone propionate, dronabinol, duazomycin, duocarmycin SA, ebselen, ecomustine, edatrexate, edelfosine, edrecolomab, eflornithine, eflornithine hydrochloride, elemene, elsamitrucin, emitefur, enloplatin, enpromate, epipropidine, epirubicin, epirubicin hydrochloride, epristeride, erbulozole, erythrocyte gene therapy vector system, esorubicin hydrochloride, estramustine, estramustine analog, estramustine phosphate sodium, estrogen agonists, estrogen antagonists, etanidazole, etoposide, etoposide phosphate, etoprine, exemestane, fadrozole, fadrozole hydrochloride, fazarabine, fenretinide, filgrastim, finasteride, flavopiridol, flezelastine, floxuridine, fluasterone, fludarabine, fludarabine phosphate, fluorodaunorunicin hydrochloride, fluorouracil, flurocitabine, forfenimex, formestane, fosquidone, fostriecin, fostriecin sodium, fotemustine, gadolinium texaphyrin, gallium nitrate, galocitabine, ganirelix, gelatinase inhibitors, gemcitabine, gemcitabine hydrochloride, glutathione inhibitors, hepsulfam, heregulin, hexamethylene bisacetamide, hydroxyurea, hypericin, ibandronic acid, idarubicin, idarubicin hydrochloride, idoxifene, idramantone, ifosfamide, ilmofosine, ilomastat, imidazoacridones, imiquimod, immunostimulant peptides, insulin-like growth factor-1 receptor inhibitor, interferon agonists, interferon alpha-2A, interferon alpha-2B, interferon alpha-N1, interferon alpha-N3, interferon beta-IA, interferon gamma-IB, interferons, interleukins, iobenguane, iododoxorubicin, iproplatin, irinotecan, irinotecan hydrochloride, iroplact, irsogladine, isobengazole, isohomohalicondrin B, itasetron, jasplakinolide, kahalalide F, lamellarin-N triacetate, lanreotide, larotaxel, lanreotide acetate, leinamycin, lenograstim, lentinan sulfate, leptolstatin, letrozole, leukemia inhibiting factor, leukocyte alpha interferon, leuprolide acetate, leuprolide/estrogen/progesterone, leuprorelin, levamisole, liarozole, liarozole hydrochloride, linear polyamine analog, lipophilic disaccharide peptide, lipophilic platinum compounds, lissoclinamide 7, lobaplatin, lombricine, lometrexol, lometrexol sodium, lomustine, lonidamine, losoxantrone, losoxantrone hydrochloride, lovastatin, loxoribine, lurtotecan, lutetium texaphyrin, lysofylline, lytic peptides, maitansine, mannostatin A, marimastat, masoprocol, maspin, matrilysin inhibitors, matrix metalloproteinase inhibitors, maytansine, maytansinoid, mertansine (DM1), mechlorethamine hydrochloride, megestrol acetate, melengestrol acetate, melphalan, menogaril, merbarone, mercaptopurine, meterelin, methioninase, methotrexate, methotrexate sodium, metoclopramide, metoprine, meturedepa, microalgal protein kinase C inhibitors, MIF inhibitor, mifepristone, miltefosine, mirimostim, mismatched double stranded RNA, mitindomide, mitocarcin, mitocromin, mitogillin, mitoguazone, mitolactol, mitomalcin, mitomycin, mitomycin analogs, mitonafide, mitosper, mitotane, mitotoxin fibroblast growth factor-saporin, mitoxantrone, mitoxantrone hydrochloride, mofarotene, molgramostim, monoclonal antibody, human chorionic gonadotrophin, monophosphoryl lipid a/myobacterium cell wall SK, mopidamol, multiple drug resistance gene inhibitor, multiple tumor suppressor 1-based therapy, mustard anticancer agent, mycaperoxide B, mycobacterial cell wall extract, mycophenolic acid, myriaporone, n-acetyldinaline, nafarelin, nagrestip, naloxone/pentazocine, napavin, naphterpin, nartograstim, nedaplatin, nemorubicin, neridronic acid, neutral endopeptidase, nilutamide, nisamycin, nitric oxide modulators, nitroxide antioxidant, nitrullyn, nocodazole, nogalamycin, n-substituted benzamides, 06-benzylguanine, octreotide, okicenone, oligonucleotides, onapristone, ondansetron, oracin, oral cytokine inducer, ormaplatin, osaterone, oxaliplatin, oxaunomycin, oxisuran, paclitaxel, paclitaxel analogs, paclitaxel derivatives, palauamine, palmitoylrhizoxin, pamidronic acid, panaxytriol, panomifene, parabactin, pazelliptine, pegaspargase, peldesine, peliomycin, pentamustine, pentosan polysulfate sodium, pentostatin, pentrozole, peplomycin sulfate, perflubron, perfosfamide, perillyl alcohol, phenazinomycin, phenylacetate, phosphatase inhibitors, picibanil, pilocarpine hydrochloride, pipobroman, piposulfan, pirarubicin, piritrexim, piroxantrone hydrochloride, placetin A, placetin B, plasminogen activator inhibitor, platinum(IV) complexes, platinum compounds, platinum-triamine complex, plicamycin, plomestane, porfimer sodium, porfiromycin, prednimustine, procarbazine hydrochloride, propyl bis-acridone, prostaglandin J2, prostatic carcinoma antiandrogen, proteasome inhibitors, protein A-based immune modulator, protein kinase C inhibitor, protein tyrosine phosphatase inhibitors, purine nucleoside phosphorylase inhibitors, puromycin, puromycin hydrochloride, purpurins, pyrazofurin, pyrazoloacridine, pyridoxylated hemoglobin polyoxy ethylene conjugate, RAF antagonists, raltitrexed, ramosetron, RAS farnesyl protein transferase inhibitors, RAS inhibitors, RAS-GAP inhibitor, retelliptine demethylated, rhenium RE 186 etidronate, rhizoxin, riboprine, ribozymes, RII retinamide, RNAi, rogletimide, rohitukine, romurtide, roquinimex, rubiginone Bl, ruboxyl, safingol, safingol hydrochloride, saintopin, sarcnu, sarcophytol A, sargramostim, SDI 1 mimetics, semustine, senescence derived inhibitor 1, sense oligonucleotides, siRNA, signal transduction inhibitors, signal transduction modulators, simtrazene, single chain antigen binding protein, sizofiran, sobuzoxane, sodium borocaptate, sodium phenylacetate, solverol, somatomedin binding protein, sonermin, sparfosate sodium, sparfosic acid, sparsomycin, spicamycin D, spirogermanium hydrochloride, spiromustine, spiroplatin, splenopentin, spongistatin 1, squalamine, stem cell inhibitor, stem-cell division inhibitors, stipiamide, streptonigrin, streptozocin, stromelysin inhibitors, sulfinosine, sulofenur, superactive vasoactive intestinal peptide antagonist, suradista, suramin, swainsonine, synthetic glycosaminoglycans, talisomycin, tallimustine, tamoxifen methiodide, tauromustine, tazarotene, tecogalan sodium, tegafur, tellurapyrylium, telomerase inhibitors, teloxantrone hydrochloride, temoporfin, temozolomide, teniposide, teroxirone, testolactone, tetrachlorodecaoxide, tetrazomine, thaliblastine, thalidomide, thiamiprine, thiocoraline, thioguanine, thiotepa, thrombopoietin, thrombopoietin mimetic, thymalfasin, thymopoietin receptor agonist, thymotrinan, thyroid stimulating hormone, tiazofurin, tin ethyl etiopurpurin, tirapazamine, titanocene dichloride, topotecan hydrochloride, topsentin, toremifene, toremifene citrate, totipotent stem cell factor, translation inhibitors, trestolone acetate, tretinoin, triacetyluridine, triciribine, triciribine phosphate, trimetrexate, trimetrexate glucuronate, triptorelin, tropisetron, tubulozole hydrochloride, turosteride, tyrosine kinase inhibitors, tyrphostins, UBC inhibitors, ubenimex, uracil mustard, uredepa, urogenital sinus-derived growth inhibitory factor, urokinase receptor antagonists, vapreotide, variolin B, velaresol, veramine, verdins, verteporfin, vinblastine sulfate, vincristine sulfate, vindesine, vindesine sulfate, vinepidine sulfate, vinglycinate sulfate, vinleurosine sulfate, vinorelbine, vinorelbine tartrate, vinrosidine sulfate, vinxaltine, vinzolidine sulfate, vitaxin, vorozole, zanoterone, zeniplatin, zilascorb, zinostatin, zinostatin stimalamer, or zorubicin hydrochloride.

In some embodiments, the active agent is a small molecule. In some embodiments, the active agent is a small molecule cytotoxin. In one embodiment, the active agent is cabazitaxel, or an analog, derivative, prodrug, or pharmaceutically acceptable salt thereof. In another embodiment, the active agent is mertansine (DM1) or DM4, or an analog, derivative, prodrug, or pharmaceutically acceptable salt thereof. DM1 or DM4 inhibits the assembly of microtubules by binding to tubulin. Structure of DM1 is shown below:

The active agent can be an inorganic or organometallic compound containing one or more metal centers. In some examples, the compound contains one metal center. The active agent can be, for example, a platinum compound, a ruthenium compound (e.g., trans-[RuCl₂ (DMSO)₄], or trans-[RuCl₄(imidazole)₂, etc.), cobalt compound, copper compound, or iron compounds.

In certain embodiments, the active agent of the conjugate comprises a predetermined molar weight percentage from about 1% to about 10%, or about 10% to about 20%, or about 20% to about 30%, or about 30% to about 40%, or about 40% to about 50%, or about 50% to about 60%, or about 60% to about 70%, or about 70% to about 80%, or about 80% to about 90%, or about 90% to about 99% such that the sum of the molar weight percentages of the components of the conjugate is 100%. The amount of active agent(s) of the conjugate may also be expressed in terms of proportion to the targeting ligand(s). For example, the present teachings provide a ratio of active agent to ligand of about 10:1, 9:1, 8:1, 7:1, 6:1, 5:1, 4:1, 3:1, 2:1, 1:1, 1:2, 1:3, 1:4; 1:5, 1:6, 1:7, 1:8, 1:9, or 1:10.

B. Targeting Moieties

Targeting ligands (also refered to as targeting moieties) as described herein include any molecule that can bind one or more SSTRs, e.g., human SSTR1, SSTR2, SSTR3, SSTR4, or SSTR5. Such targeting ligands can be peptides, antibody mimetics, nucleic acids (e.g., aptamers), polypeptides (e.g., antibodies), glycoproteins, small molecules, carbohydrates, or lipids. In some embodiments, the targeting moiety is somatostatin or a somatostation analog.

The cytotoxic or therapeutic conjugates of the invention can employ any somatostatin analog that binds somatostatin receptor. In some embodiments, the somatostatin analog portion of the conjugate contains between 8 and 18 amino acids, and includes the core sequence: cyclo[Cys-Phe-D-Trp-Lys-Thr-Cys] or cyclo[Cys-Tyr-D-Trp-Lys-Thr-Cys]. For example, the C-terminus of the analog is Thr-NH₂.

In one embodiment, the targeting moiety binds preferably to SSTR2. Therefore, the conjugate comprising the targeting moiety binds preferably to SSTR2. The binding of the conjugate to SSTR2 is stronger than the binding of the conjugate to SSTR1, SSTR3, SSTR4 or SSTR5.

In some embodiments, the conjugates as described herein have low membrane permeability. Membrane permeability may be low in both the apical to basolateral direction and the basolateral to apical direction. Not wiling to be bound by any theory, low membrane permeability enhances selective uptake by SSTRs by decreasing non-specific permeability. Low permeability leads to decreased uptake in cells that do not express SSTR2, leading to lower toxicity to non-SSTR2 expressing cells. Membrane permeability may be determined by any method known in the art. For example, it may be determined by measuring apparent permeability (Papp) in Caco-2 monolayers.

In some embodiments, the targeting moiety, X, may be selected from somatostatin, octreotide, lanreotide, lutathera (¹⁷⁷Lu-DOTATATE), ⁹⁰Y-DOTATOC, Tyr³-octreotate (TATE), vapreotide, cyclo(AA-Tyr-DTrp-Lys-Thr-Phe) where AA is α-N-Me lysine or N-Me glutamic acid, pasireotide, lanreotide, seglitide, or any other example of somatostatin receptor binding ligands. In some embodiments, the targeting moiety is a somatostatin receptor binding moiety that binds to somatostatin receptors 2 and/or 5. In some embodiments, X binds to the linker moiety Y at the C-terminal. In some embodiments, X binds to the linker moiety Y at the N-terminal. In some embodiments, the targeting moiety X comprises at least one D-Phe residue and the phenyl ring of the D-Phe residue of the targeting moiety X has been replaced by a linker-containing moiety.

Examples of somatostatin analogs that are peptides useful in the present invention are described herein. Further examples useful somatostatin analogs are disclosed in publications set forth below, each of which is hereby incorporated by reference in its entirety:

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Methods for synthesizing somatostatin peptides and analogs are well documented and are within the ability of a person of ordinary skill in the art as exemplified in the references listed supra. Further synthetic procedures are provided in the following examples. The following examples also illustrate methods for synthesizing the targeted cytotoxic compounds of the present invention. Specific targeting of therapeutic or cytotoxic agents allows selective destruction of a tumor expressing a receptor specific for a biologically active peptide. For example, a tumor expressing a somatostatin receptor includes a neoplasm of the lung, breast, prostate, colon, brain, gastrointestinal tract, neuroendocrine axis, liver, or kidney (see Schaer et al., Int. J. Cancer, 70:530-537, 1997; Chave et al., Br. J. Cancer 82(1):124-130, 2000; Evans et al., Br. J. Cancer 75(6):798-803, 1997).

In some embodiments, the targeting moiety has therapeutic features, e.g., the targeting moiety is cytotoxic or anti-angiogenic. In some embodiments, a targeting moiety has some increased affinity for tumor vasculature, or angiogenic blood vessels, e.g., those that over-express somatostatin receptors (see Denzler and Reubi, Cancer 85:188-198, 1999; Gulec et al., J. Surg. Res. 97(2):131-137, 2001; Woltering et al., J. Surg. Res. 50:245, 1991).

In some embodiments, the targeting moiety, e.g., somatostatin analog, used in the invention is hydrophilic, and is therefore water soluble. In some embodiments, such conjugates and particles containing such conjugates are used in treatment paradigms in which this feature is useful, e.g., compared to conjugates comprising hydrophobic analogs. Hydrophilic analogs described herein can be soluble in blood, cerebrospinal fluid, and other bodily fluids, as well as in urine, which may facilitate excretion by the kidneys. This feature can be useful, e.g., in the case of a composition that would otherwise exhibit undesirable liver toxicity. The invention also discloses specific hydrophilic elements (e.g., incorporation of a PEG linker, and other examples in the art) for incorporation into peptide analogs, allowing modulation of the analog's hydrophilicity to adjust for the chemical and structural nature of the various conjugated cytotoxic agents, e.g., conjugate 6 infra.

In some embodiments, the targeting moiety is an antibody mimetic such as a monobody, e.g., an ADNECTIN™ (Bristol-Myers Squibb, New York, N.Y.), an Affibody® (Affibody AB, Stockholm, Sweden), Affilin, nanofitin (affitin, such as those described in WO 2012/085861, an Anticalin™, an avimers (avidity multimers), a DARPin™, a Fynomer™, Centyrin™ and a Kunitz domain peptide. In certain cases, such mimetics are artificial peptides or proteins with a molar mass of about 3 to 20 kDa. Nucleic acids and small molecules may be antibody mimetic.

In another example, a targeting moiety can be an aptamer, which is generally an oligonucleotide (e.g., DNA, RNA, or an analog or derivative thereof) that binds to a particular target, such as a polypeptide. In some embodiments, the targeting moiety is a polypeptide (e.g., an antibody that can specifically bind a tumor marker). In certain embodiments, the targeting moiety is an antibody or a fragment thereof. In certain embodiments, the targeting moiety is an Fc fragment of an antibody.

In certain embodiments, the targeting moiety or moieties of the conjugate are present at a predetermined molar weight percentage from about 0.1% to about 10%, or about 1% to about 10%, or about 10% to about 20%, or about 20% to about 30%, or about 30% to about 40%, or about 40% to about 50%, or about 50% to about 60%, or about 60% to about 70%, or about 70% to about 80%, or about 80% to about 90%, or about 90% to about 99% such that the sum of the molar weight percentages of the components of the conjugate is 100%. The amount of targeting moieties of the conjugate may also be expressed in terms of proportion to the active agent(s), for example, in a ratio of ligand to active agent of about 10:1, 9:1, 8:1, 7:1, 6:1, 5:1, 4:1, 3:1, 2:1, 1:1, 1:2, 1:3, 1:4; 1:5, 1:6, 1:7, 1:8, 1:9, or 1:10.

C. Linkers

The conjugates contain one or more linkers attaching the active agents and targeting moieties. The linker, Y, is bound to one or more active agents and one or more targeting ligands to form a conjugate. The linker Y is attached to the targeting moiety X and the active agent Z by functional groups independently selected from an ester bond, disulfide, amide, acylhydrazone, ether, carbamate, carbonate, and urea. Alternatively the linker can be attached to either the targeting ligand or the active drug by a non-cleavable group such as provided by the conjugation between a thiol and a maleimide, an azide and an alkyne. The linker is independently selected from the group consisting alkyl, cycloalkyl, heterocyclyl, aryl, and heteroaryl, wherein each of the alkyl, alkenyl, cycloalkyl, heterocyclyl, aryl, and heteroaryl groups optionally is substituted with one or more groups, each independently selected from halogen, cyano, nitro, hydroxyl, carboxyl, carbamoyl, ether, alkoxy, aryloxy, amino, amide, carbamate, alkyl, alkenyl, alkynyl, aryl, arylalkyl, cycloalkyl, heteroaryl, heterocyclyl, wherein each of the carboxyl, carbamoyl, ether, alkoxy, aryloxy, amino, amide, carbamate, alkyl, alkenyl, alkynyl, aryl, arylalkyl, cycloalkyl, heteroaryl, or heterocyclyl is optionally substituted with one or more groups, each independently selected from halogen, cyano, nitro, hydroxyl, carboxyl, carbamoyl, ether, alkoxy, aryloxy, amino, amide, carbamate, alkyl, alkenyl, alkynyl, aryl, arylalkyl, cycloalkyl, heteroaryl, heterocyclyl.

In some embodiments, the linker comprises a cleavable functionality that is cleavable. The cleavable functionality may be hydrolyzed in vivo or may be designed to be hydrolyzed enzymatically, for example by Cathepsin B. A “cleavable” linker, as used herein, refers to any linker which can be cleaved physically or chemically. Examples for physical cleavage may be cleavage by light, radioactive emission or heat, while examples for chemical cleavage include cleavage by re-dox-reactions, hydrolysis, pH-dependent cleavage or cleavage by enzymes.

In some embodiments the alkyl chain of the linker may optionally be interrupted by one or more atoms or groups selected from —O—, —C(═O)—, —NR, —O—C(═O)—NR—, —S—, —S—S—. The linker may be selected from dicarboxylate derivatives of succinic acid, glutaric acid or diglycolic acid. In some embodiments, the linker Y may be X′—R¹—Y′—R¹—Z′ and the conjugate can be a compound according to Formula Ia:

-   -   wherein X is a targeting moiety defined above; Z is an active         agent; X′, R¹, Y′, R² and Z′ are as defined herein.

X′ is either absent or independently selected from carbonyl, amide, urea, amino, ester, aryl, arylcarbonyl, aryloxy, arylamino, one or more natural or unnatural amino acids, thio or succinimido; R¹ and R² are either absent or comprised of alkyl, substituted alkyl, aryl, substituted aryl, polyethylene glycol (2-30 units); Y′ is absent, substituted or unsubstituted 1,2-diaminoethane, polyethylene glycol (2-30 units) or an amide; Z′ is either absent or independently selected from carbonyl, amide, urea, amino, ester, aryl, arylcarbonyl, aryloxy, arylamino, thio or succinimido. In some embodiments, the linker can allow one active agent molecule to be linked to two or more ligands, or one ligand to be linked to two or more active agent molecule.

In some embodiments, the linker Y may be A_(m) and the conjugate can be a compound according to Formula Ib:

-   -   wherein A is defined herein, m=0-20.

A in Formula Ia is a spacer unit, either absent or independently selected from the following substituents. For each substituent, the dashed lines represent substitution sites with X, Z or another independently selected unit of A wherein the X, Z, or A can be attached on either side of the substituent:

wherein z=0-40, R is H or an optionally substituted alkyl group, and R′ is any side chain found in either natural or unnatural amino acids.

In some embodiments, the conjugate may be a compound according to Formula Ic:

wherein A is defined above, m=0-40, n=0-40, x=1-5, y=1-5, and C is a branching element defined herein.

C in Formula Ic is a branched unit containing three to six functionalities for covalently attaching spacer units, ligands, or active drugs, selected from amines, carboxylic acids, thiols, or succinimides, including amino acids such as lysine, 2,3-diaminopropanoic acid, 2,4-diaminobutyric acid, glutamic acid, aspartic acid, and cysteine.

Non-limiting examples of conjugates of the present invention include the following compounds:

In some embodiments, the active agent Z is DM1 and the somatostatin receptor binding agent X is selected from somatostatin, cyclo(AA-Tyr-DTrp-Lys-Thr-Phe), vapreotide or TATE. In some embodiments, DM1 is connected to the C-terminus of X with the linker Y. In some embodiments, DM1 is connected to the N-terminus of X with the linker Y. In some embodiments, DM1 is connected to X with the linker Y, wherein the targeting moiety X comprises at least one D-Phe residue and the phenyl ring of the D-Phe residue has been replaced by a group containing linker Y.

Non-limiting examples of conjugates comprising DM1, referred to as DM1 conjugates of the invention, include the following compounds:

1) cyclo(AA-Tyr-DTrp-Lys-Thr-Phe)-based DM1 conjugates

In some embodiments, cyclo(AA-Tyr-DTrp-Lys-Thr-Phe) is used as a somatostatin receptor targeting moiety and the conjugates have a general structure of:

In some embodiments, the targeting moiety contains an amino acid capable of making an amide bond. In some embodiments, the linker is bound to the targeting moiety via an amide bond, i.e., —NH—CO—, or —CO—NH— (the hydrogen on the nitrogen may be substituted). In some embodiments, the linker is not bound to the targeting moiety via an amide bond. In somebodiments, the linker includes an amide bond, i.e., —NH—CO—, or —CO—NH— (the hydrogen on the nitrogen may be substituted).

Non-limiting examples of conjugates comprising cyclo(AA-Tyr-DTrp-Lys-Thr-Phe) and DM1 are shown in Table 1 of PCT Application No. PCT/US15/38569 (WO2016/004048) filed Jun. 30, 2015, the contents of which are incorporated herein by reference.

2)C-Terminal DMI Conjugates

In some embodiments, the somatostatin receptor targeting moiety is a peptide and the linker binds to the C-terminus of the somatostatin receptor targeting moiety. In some embodiments, the somatostatin receptor targeting moiety is TATE or a TATE derivative, wherein the linker binds to the C-terminus of TATE or the TATE derivative, referred to as C-terminal TATE-based DM1 conjugate. The C-terminal DM1 conjugates have a general structure of:

wherein R is selected from H, alkyl, aryl, carbonyl, amide, alcohol, or amine, optionally substituted with one or more groups; and Ar₁ and Ar₂ are independently selected from heterocyclyl, aryl, and heteroaryl groups optionally substituted with one or more groups.

In some embodiments, the covalent bond connecting the linker and the C-terminus of the somatostatin receptor targeting moiety is an amide bond.

Non-limiting examples of DM1 conjugates wherein the linker binds to the C-terminus of the somatostatin receptor targeting moiety, wherein the somatostatin receptor targeting moiety is TATE, are shown in Table 2 of PCT Application No. PCT/US15/38569 (WO2016/004048) filed Jun. 30, 2015, the contents of which are incorporated herein by reference.

In some embodiments, the conjugate is Conjugate 57.

R Ar1 Ar2 Linker* Full Structure H

3) N-Terminal DM1 Conjugates

In some embodiments, the somatostatin receptor targeting moiety is a peptide and the linker binds to the N-terminus of the somatostatin receptor targeting moiety. In some embodiments, the target moiety is selected from octreotide, vapreotide, and TATE. In some embodiments, the covalent bond connecting the linker and the N-terminal of the somatostatin receptor targeting moiety is an amide bond, i.e., —NH—CO—. In some embodiments, the linker binds to the N-terminus of the somatostatin receptor targeting moiety via an amine bond, i.e., —NH—CH₂— (hydrogen on the carbon may be substituted). In some embodiments, the linker binds to the N-terminus of the somatostatin receptor targeting moiety via a urea bond, i.e. —NH—CO—NH—. The N-terminal DM1 conjugate has a general structure of:

wherein R₁ and R₂ are independently selected from H, OH, alkyl, aryl, carbonyl, ester, amide, ether, alcohol, or amine, optionally substituted with one or more groups; and Ar₁ is selected from heterocyclyl, aryl, and heteroaryl groups optionally substituted with one or more groups. In some embodiments, at least one of R1 or R2 comprises DM1.

Non-limiting examples of DM1 conjugates wherrein the linker binds to the N-terminus of the somatostatin receptor targeting moiety are shown in Table 3 of PCT Application No. PCT/US15/38569 (WO2016/004048) filed Jun. 30, 2015, the contents of which are incorporated herein by reference.

4) D-Phe Replacement DM1 Conjugates

In some embodiments, the somatostatin receptor targeting moiety is a targeting ligand such as octreotide or TATE, wherein the phenyl ring of the D-Phe residue of the targeting ligand has been replaced by a linker-containing moiety. The D-Phe replacement DM1 conjugate has a general structure of:

wherein R is selected from H, OH, alkyl, aryl, carbonyl, ester, amide, ether, alcohol, or amine, optionally substituted with one or more groups. In some embodiments, R comprises DM1.

Non-limiting examples of DM1 conjugates wherein the phenyl ring of the D-Phe residue of the targeting ligand has been replaced by a linker-containing moiety are shown in Table 4 of PCT Application No. PCT/US15/38569 (WO2016/004048) filed Jun. 30, 2015, the contents of which are incorporated herein by reference.

II. Particles

Particles containing one or more conjugates can be polymeric particles, lipid particles, solid lipid particles, inorganic particles, or combinations thereof (e.g., lipid stabilized polymeric particles). In some embodiments, the particles are polymeric particles or contain a polymeric matrix. The particles can contain any of the polymers described herein or derivatives or copolymers thereof. The particles generally contain one or more biocompatible polymers. The polymers can be biodegradable polymers. The polymers can be hydrophobic polymers, hydrophilic polymers, or amphiphilic polymers. In some embodiments, the particles contain one or more polymers having an additional targeting moiety attached thereto.

The size of the particles can be adjusted for the intended application. The particles can be nanoparticles or microparticles. The particle can have a diameter of about 10 nm to about 10 microns, about 10 nm to about 1 micron, about 10 nm to about 500 nm, about 20 nm to about 500 nm, or about 25 nm to about 250 nm. In some embodiments the particle is a nanoparticle having a diameter from about 25 nm to about 250 nm. It is understood by those in the art that a plurality of particles will have a range of sizes and the diameter is understood to be the median diameter of the particle size distribution.

In various embodiments, a particle may be a nanoparticle, i.e., the particle has a characteristic dimension of less than about 1 micrometer, where the characteristic dimension of a particle is the diameter of a perfect sphere having the same volume as the particle. The plurality of particles can be characterized by an average diameter (e.g., the average diameter for the plurality of particles). In some embodiments, the diameter of the particles may have a Gaussian-type distribution. In some embodiments, the plurality of particles have an average diameter of less than about 300 nm, less than about 250 nm, less than about 200 nm, less than about 150 nm, less than about 100 nm, less than about 50 nm, less than about 30 nm, less than about 10 nm, less than about 3 nm, or less than about 1 nm. In some embodiments, the particles have an average diameter of at least about 5 nm, at least about 10 nm, at least about 30 nm, at least about 50 nm, at least about 100 nm, at least about 150 nm, or greater. In certain embodiments, the plurality of the particles have an average diameter of about 10 nm, about 25 nm, about 50 nm, about 100 nm, about 150 nm, about 200 nm, about 250 nm, about 300 nm, about 500 nm, or the like. In some embodiments, the plurality of particles have an average diameter between about 10 nm and about 500 nm, between about 50 nm and about 400 nm, between about 100 nm and about 300 nm, between about 150 nm and about 250 nm, between about 175 nm and about 225 nm, or the like. In some embodiments, the plurality of particles have an average diameter between about 10 nm and about 500 nm, between about 20 nm and about 400 nm, between about 30 nm and about 300 nm, between about 40 nm and about 200 nm, between about 50 nm and about 175 nm, between about 60 nm and about 150 nm, between about 70 nm and about 130 nm, or the like. For example, the average diameter can be between about 70 nm and 130 nm. In some embodiments, the plurality of particles have an average diameter between about 20 nm and about 220 nm, between about 30 nm and about 200 nm, between about 40 nm and about 180 nm, between about 50 nm and about 170 nm, between about 60 nm and about 150 nm, or between about 70 nm and about 130 nm. In one embodiment, the particles have a size of 40 to 120 nm with a zeta potential close to 0 mV at low to zero ionic strengths (1 to 10 mM), with zeta potential values between +5 to −5 mV, and a zero/neutral or a small −ve surface charge.

A. Conjugates

The particles contain one or more conjugates as described above. The conjugates can be present on the interior of the particle, on the exterior of the particle, or both. The particles may comprise hydrophobic ion-pairing complexes or hydrophobic ion-pairs formed by one or more conjugates described above and counterions.

Hydrophobic ion-pairing (HIP) is the interaction between a pair of oppositely charged ions held together by Coulombic attraction. HIP, as used here in, refers to the interaction between the conjugate of the present invention and its counterions, wherein the counterion is not H⁺ or HO⁻ ions. Hydrophobic ion-pairing complex or hydrophobic ion-pair, as used herein, refers to the complex formed by the conjugate of the present invention and its counterions. In some embodiments, the counterions are hydrophobic. In some embodiments, the counterions are provided by a hydrophobic acid or a salt of a hydrophobic acid. In some embodiments, the counterions are provided by bile acids or salts, fatty acids or salts, lipids, or amino acids. In some embodiments, the counterions are negatively charged (anionic). Non-limited examples of negative charged counterions include the counterions sodium sulfosuccinate (AOT), sodium oleate, sodium dodecyl sulfate (SDS), human serum albumin (HSA), dextran sulphate, sodium deoxycholate, sodium cholate, anionic lipids, amino acids, or any combination thereof. Without wishing to be bound by any theory, in some embodiments, HIP may increase the hydrophobicity and/or lipophilicity of the conjugate of the present invention. In some embodiments, increasing the hydrophobicity and/or lipophilicity of the conjugate of the present invention may be beneficial for particle formulations and may provide higher solubility of the conjugate of the present invention in organic solvents. Without wishing to be bound by any theory, it is believed that particle formulations that include HIP pairs have improved formulation properties, such as drug loading and/or release profile. Without wishing to be bound by any theory, in some embodiments, slow release of the conjugate of the invention from the particles may occur, due to a decrease in the conjugate's solubility in aqueous solution. In addition, without wishing to be bound by any theory, complexing the conjugate with large hydrophobic counterions may slow diffusion of the conjugate within a polymeric matrix. In some emobodiments, HIP occurs without covalent conjuatation of the counterion to the conjugate of the present invention.

Without wishing to be bound by any theory, the strength of HIP may impact the drug load and release rate of the particles of the invention. In some embodiments, the strength of the HIP may be increased by increasing the magnitude of the difference between the pKa of the conjugate of the present invention and the pKa of the agent providing the counterion. Also without wishing to be bound by any theory, the conditions for ion pair formation may impact the drug load and release rate of the particles of the invention.

In some embodiments, any suitable hydrophobic acid or a combination thereof may form a HIP pair with the conjugate of the present invention. In some embodiments, the hydrophobic acid may be a carboxylic acid (such as but not limited to a monocarboxylic acid, dicarboxylic acid, tricarboxylic acid), a sulfinic acid, a sulfenic acid, or a sulfonic acid. In some embodiments, a salt of a suitable hydrophobic acid or a combination thereof may be used to form a HIP pair with the conjugate of the present invention. Examples of hydrophobic acids, saturated fatty acids, unsaturated fatty acids, aromatic acids, bile acid, polyelectrolyte, their dissociation constant in water (pKa) and log P values were disclosed in WO2014/043,625, the contents of which are incorporated herein by reference in their entirety. The strength of the hydrophobic acid, the difference between the pKa of the hydrophobic acid and the pKa of the conjuagate of the present invention, log P of the hydrophobic acid, the phase transition temperature of the hydrophobic acid, the molar ratio of the hydrophobic acid to the conjugate of the present invention, and the concentration of the hydrophobic acid were also disclosed in WO2014/043,625, the contents of which are incorporated herein by reference in their entirety.

In some embodiments, particles of the present invention comprising a HIP complex and/or prepared by a process that provides a counterion to form HIP complex with the conjugate may have a highter drug loading than particles without a HIP complex or prepared by a process that does not provide any counterion to form HIP complex with the conjugate. In some embodiments, drug loading may increase 50%, 100%, 2 times, 3 times, 4 times, 5 times, 6 times, 7 times, 8 times, 9 times, or 10 times.

In some embodiments, the particles of the invention may retain the conjugate for at least about 1 minute, at least about 15 minutes, at least about 1 hour, when placed in a phosphate buffer solution at 37° C.

In some embodiments, the weight percentage of the conjugate in the particles is at least about 0.05%, 0.1%, 0.5%, 1%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, or 50% such that the sum of the weight percentages of the components of the particles is 100%. In some embodiments, the weight percentage of the conjugate in the particles is from about 0.5% to about 10%, or about 10% to about 20%, or about 20% to about 30%, or about 30% to about 40%, or about 40% to about 50%, or about 50% to about 60%, or about 60% to about 70%, or about 70% to about 80%, or about 80% to about 90%, or about 90% to about 99% such that the sum of the weight percentages of the components of the particles is 100%.

In some instances, a conjugate may have a molecular weight of less than about 50,000 Da, less than about 40,000 Da, less than about 30,000 Da, less than about 20,000 Da, less than about 15,000 Da, less than about 10,000 Da, less than about 8,000 Da, less than about 5,000 Da, or less than about 3,000 Da. In some cases, the conjugate may have a molecular weight of between about 1,000 Da and about 50,000 Da, between about 1,000 Da and about 40,000 Da, in some embodiments between about 1,000 Da and about 30,000 Da, in some embodiments bout 1,000 Da and about 50,000 Da, between about 1,000 Da and about 20,000 Da, in some embodiments between about 1,000 Da and about 15,000 Da, in some embodiments between about 1,000 Da and about 10,000 Da, in some embodiments between about 1,000 Da and about 8,000 Da, in some embodiments between about 1,000 Da and about 5,000 Da, and in some embodiments between about 1,000 Da and about 3,000 Da. The molecular weight of the conjugate may be calculated as the sum of the atomic weight of each atom in the formula of the conjugate multiplied by the number of each atom. It may also be measured by mass spectrometry, NMR, chromatography, light scattering, viscosity, and/or any other methods known in the art. It is known in the art that the unit of molecular weight may be g/mol, Dalton (Da), or atomic mass unit (amu), wherein 1 g/mol=1 Da=1 amu.

B. Polymers

The particles may contain one or more polymers. Polymers may contain one more of the following polyesters: homopolymers including glycolic acid units, referred to herein as “PGA”, and lactic acid units, such as poly-L-lactic acid, poly-D-lactic acid, poly-D,L-lactic acid, poly-L-lactide, poly-D-lactide, and poly-D,L-lactide, collectively referred to herein as “PLA”, and caprolactone units, such as poly(ε-caprolactone), collectively referred to herein as “PCL”; and copolymers including lactic acid and glycolic acid units, such as various forms of poly(lactic acid-co-glycolic acid) and poly(lactide-co-glycolide) characterized by the ratio of lactic acid:glycolic acid, collectively referred to herein as “PLGA”; and polyacrylates, and derivatives thereof. Exemplary polymers also include copolymers of polyethylene glycol (PEG) and the aforementioned polyesters, such as various forms of PLGA-PEG or PLA-PEG copolymers, collectively referred to herein as “PEGylated polymers”. In certain embodiments, the PEG region can be covalently associated with polymer to yield “PEGylated polymers” by a cleavable linker.

The particles may contain one or more hydrophilic polymers. Hydrophilic polymers include cellulosic polymers such as starch and polysaccharides; hydrophilic polypeptides; poly(amino acids) such as poly-L-glutamic acid (PGS), gamma-polyglutamic acid, poly-L-aspartic acid, poly-L-serine, or poly-L-lysine; polyalkylene glycols and polyalkylene oxides such as polyethylene glycol (PEG), polypropylene glycol (PPG), and poly(ethylene oxide) (PEO); poly(oxyethylated polyol); poly(olefinic alcohol); polyvinylpyrrolidone); poly(hydroxyalkylmethacrylamide); poly(hydroxyalkylmethacrylate); poly(saccharides); poly(hydroxy acids); poly(vinyl alcohol); polyoxazoline; and copolymers thereof.

The particles may contain one or more hydrophobic polymers. Examples of suitable hydrophobic polymers include polyhydroxyacids such as poly(lactic acid), poly(glycolic acid), and poly(lactic acid-co-glycolic acids); polyhydroxyalkanoates such as poly3-hydroxybutyrate or poly4-hydroxybutyrate; polycaprolactones; poly(orthoesters); polyanhydrides; poly(phosphazenes); poly(lactide-co-caprolactones); polycarbonates such as tyrosine polycarbonates; polyamides (including synthetic and natural polyamides), polypeptides, and poly(amino acids); polyesteramides; polyesters; poly(dioxanones); poly(alkylene alkylates); hydrophobic polyethers; polyurethanes; polyetheresters; polyacetals; polycyanoacrylates; polyacrylates; polymethylmethacrylates; polysiloxanes; poly(oxyethylene)/poly(oxypropylene) copolymers; polyketals; polyphosphates; polyhydroxyvalerates; polyalkylene oxalates; polyalkylene succinates; poly(maleic acids), as well as copolymers thereof.

In certain embodiments, the hydrophobic polymer is an aliphatic polyester. In some embodiments, the hydrophobic polymer is poly(lactic acid), poly(glycolic acid), or poly(lactic acid-co-glycolic acid).

The particles can contain one or more biodegradable polymers. Biodegradable polymers can include polymers that are insoluble or sparingly soluble in water that are converted chemically or enzymatically in the body into water-soluble materials. Biodegradable polymers can include soluble polymers crosslinked by hydolyzable cross-linking groups to render the crosslinked polymer insoluble or sparingly soluble in water.

Biodegradable polymers in the particle can include polyamides, polycarbonates, polyalkylenes, polyalkylene glycols, polyalkylene oxides, polyalkylene terepthalates, polyvinyl alcohols, polyvinyl ethers, polyvinyl esters, polyvinyl halides, polyvinylpyrrolidone, polyglycolides, polysiloxanes, polyurethanes and copolymers thereof, alkyl cellulose such as methyl cellulose and ethyl cellulose, hydroxyalkyl celluloses such as hydroxypropyl cellulose, hydroxy-propyl methyl cellulose, and hydroxybutyl methyl cellulose, cellulose ethers, cellulose esters, nitro celluloses, cellulose acetate, cellulose propionate, cellulose acetate butyrate, cellulose acetate phthalate, carboxylethyl cellulose, cellulose triacetate, cellulose sulphate sodium salt, polymers of acrylic and methacrylic esters such as poly (methyl methacrylate), poly(ethylmethacrylate), poly(butylmethacrylate), poly(isobutylmethacrylate), poly(hexlmethacrylate), poly(isodecylmethacrylate), poly(lauryl methacrylate), poly (phenyl methacrylate), poly(methyl acrylate), poly(isopropyl acrylate), poly(isobutyl acrylate), poly(octadecyl acrylate), polyethylene, polypropylene poly(ethylene glycol), poly(ethylene oxide), poly(ethylene terephthalate), poly(vinyl alcohols), poly(vinyl acetate, poly vinyl chloride polystyrene and polyvinylpryrrolidone, derivatives thereof, linear and branched copolymers and block copolymers thereof, and blends thereof. Exemplary biodegradable polymers include polyesters, poly(ortho esters), poly(ethylene imines), poly(caprolactones), poly(hydroxyalkanoates), poly(hydroxyvalerates), polyanhydrides, poly(acrylic acids), polyglycolides, poly(urethanes), polycarbonates, polyphosphate esters, polyphosphazenes, derivatives thereof, linear and branched copolymers and block copolymers thereof, and blends thereof. In some embodiments the particle contains biodegradable polyesters or polyanhydrides such as poly(lactic acid), poly(glycolic acid), and poly(lactic-co-glycolic acid).

The particles can contain one or more amphiphilic polymers. Amphiphilic polymers can be polymers containing a hydrophobic polymer block and a hydrophilic polymer block. The hydrophobic polymer block can contain one or more of the hydrophobic polymers above or a derivative or copolymer thereof. The hydrophilic polymer block can contain one or more of the hydrophilic polymers above or a derivative or copolymer thereof. In some embodiments the amphiphilic polymer is a di-block polymer containing a hydrophobic end formed from a hydrophobic polymer and a hydrophilic end formed of a hydrophilic polymer. In some embodiments, a moiety can be attached to the hydrophobic end, to the hydrophilic end, or both. The particle can contain two or more amphiphilic polymers.

C. Lipids

The particles may contain one or more lipids or amphiphilic compounds. For example, the particles can be liposomes, lipid micelles, solid lipid particles, or lipid-stabilized polymeric particles. The lipid particle can be made from one or a mixture of different lipids. Lipid particles are formed from one or more lipids, which can be neutral, anionic, or cationic at physiologic pH. The lipid particle, in some embodiments, incorporates one or more biocompatible lipids. The lipid particles may be formed using a combination of more than one lipid. For example, a charged lipid may be combined with a lipid that is non-ionic or uncharged at physiological pH.

The particle can be a lipid micelle. Lipid micelles for drug delivery are known in the art. Lipid micelles can be formed, for instance, as a water-in-oil emulsion with a lipid surfactant. An emulsion is a blend of two immiscible phases wherein a surfactant is added to stabilize the dispersed droplets. In some embodiments the lipid micelle is a microemulsion. A microemulsion is a thermodynamically stable system composed of at least water, oil and a lipid surfactant producing a transparent and thermodynamically stable system whose droplet size is less than 1 micron, from about 10 nm to about 500 nm, or from about 10 nm to about 250 nm. Lipid micelles are generally useful for encapsulating hydrophobic active agents, including hydrophobic therapeutic agents, hydrophobic prophylactic agents, or hydrophobic diagnostic agents.

The particle can be a liposome. Liposomes are small vesicles composed of an aqueous medium surrounded by lipids arranged in spherical bilayers. Liposomes can be classified as small unilamellar vesicles, large unilamellar vesicles, or multi-lamellar vesicles. Multi-lamellar liposomes contain multiple concentric lipid bilayers. Liposomes can be used to encapsulate agents, by trapping hydrophilic agents in the aqueous interior or between bilayers, or by trapping hydrophobic agents within the bilayer.

The lipid micelles and liposomes typically have an aqueous center. The aqueous center can contain water or a mixture of water and alcohol. Suitable alcohols include, but are not limited to, methanol, ethanol, propanol, (such as isopropanol), butanol (such as n-butanol, isobutanol, sec-butanol, tert-butanol, pentanol (such as amyl alcohol, isobutyl carbinol), hexanol (such as 1-hexanol, 2-hexanol, 3-hexanol), heptanol (such as 1-heptanol, 2-heptanol, 3-heptanol and 4-heptanol) or octanol (such as 1-octanol) or a combination thereof.

The particle can be a solid lipid particle. Solid lipid particles present an alternative to the colloidal micelles and liposomes. Solid lipid particles are typically submicron in size, i.e. from about 10 nm to about 1 micron, from 10 nm to about 500 nm, or from 10 nm to about 250 nm. Solid lipid particles are formed of lipids that are solids at room temperature. They are derived from oil-in-water emulsions, by replacing the liquid oil by a solid lipid.

Suitable neutral and anionic lipids include, but are not limited to, sterols and lipids such as cholesterol, phospholipids, lysolipids, lysophospholipids, sphingolipids or pegylated lipids. Neutral and anionic lipids include, but are not limited to, phosphatidylcholine (PC) (such as egg PC, soy PC), including 1,2-diacyl-glycero-3-phosphocholines; phosphatidylserine (PS), phosphatidylglycerol, phosphatidylinositol (PI); glycolipids; sphingophospholipids such as sphingomyelin and sphingoglycolipids (also known as 1-ceramidyl glucosides) such as ceramide galactopyranoside, gangliosides and cerebrosides; fatty acids, sterols, containing a carboxylic acid group for example, cholesterol; 1,2-diacyl-sn-glycero-3-phosphoethanolamine, including, but not limited to, 1,2-dioleylphosphoethanolamine (DOPE), 1,2-dihexadecylphosphoethanolamine (DHPE), 1,2-di stearoylphosphatidylcholine (DSPC), 1,2-dipalmitoyl phosphatidylcholine (DPPC), and 1,2-dimyristoylphosphatidylcholine (DMPC). The lipids can also include various natural (e.g., tissue derived L-α-phosphatidyl: egg yolk, heart, brain, liver, soybean) and/or synthetic (e.g., saturated and unsaturated 1,2-diacyl-sn-glycero-3-phosphocholines, 1-acyl-2-acyl-sn-glycero-3-phosphocholines, 1,2-diheptanoyl-SN-glycero-3-phosphocholine) derivatives of the lipids.

Suitable cationic lipids include, but are not limited to, N-[1-(2,3-dioleoyloxy)propyl]-N,N,N-trimethyl ammonium salts, also references as TAP lipids, for example methylsulfate salt. Suitable TAP lipids include, but are not limited to, DOTAP (dioleoyl-), DMTAP (dimyristoyl-), DPTAP (dipalmitoyl-), and DSTAP (distearoyl-). Suitable cationic lipids in the liposomes include, but are not limited to, dimethyldioctadecyl ammonium bromide (DDAB), 1,2-diacyloxy-3-trimethylammonium propanes, N-[1-(2,3-dioloyloxy)propyl]-N,N-dimethyl amine (DODAP), 1,2-diacyloxy-3-dimethylammonium propanes, N-[1-(2,3-dioleyloxy)propyl]-N,N,N-trimethylammonium chloride (DOTMA), 1,2-dialkyloxy-3-dimethylammonium propanes, dioctadecylamidoglycylspermine (DOGS), 3-[N—(N′,N′-dimethylamino-ethane)carbamoyl] cholesterol (DC-Chol); 2,3-dioleoyloxy-N-(2-(sperminecarboxamido)-ethyl)-N,N-dimethyl-1-propanaminium trifluoro-acetate (DOSPA), β-alanyl cholesterol, cetyl trimethyl ammonium bromide (CTAB), diC₁₄-amidine, N-ferf-butyl-N′-tetradecyl-3-tetradecylamino-propionamidine, N-(alpha-trimethylammonioacetyl)didodecyl-D-glutamate chloride (TMAG), ditetradecanoyl-N-(trimethylammonio-acetyl)diethanolamine chloride, 1,3-dioleoyloxy-2-(6-carboxy-spermyl)-propylamide (DOSPER), and N, N, N′, N′-tetramethyl-, N′-bis(2-hydroxylethyl)-2,3-dioleoyloxy-1,4-butanediammonium iodide. In one embodiment, the cationic lipids can be 1-[2-(acyloxy)ethyl]2-alkyl(alkenyl)-3-(2-hydroxyethyl)-imidazolinium chloride derivatives, for example, 1-[2-(9(Z)-octadecenoyloxy)ethyl]-2-(8(Z)-heptadecenyl-3-(2-hydroxyethyl)imidazolinium chloride (DOTIM), and 1-[2-(hexadecanoyloxy)ethyl]-2-pentadecyl-3-(2-hydroxyethyl)imidazolinium chloride (DPTIM). In one embodiment, the cationic lipids can be 2,3-dialkyloxypropyl quaternary ammonium compound derivatives containing a hydroxyalkyl moiety on the quaternary amine, for example, 1,2-dioleoyl-3-dimethyl-hydroxyethyl ammonium bromide (DORI), 1,2-dioleyloxypropyl-3-dimethyl-hydroxyethyl ammonium bromide (DORIE), 1,2-dioleyloxypropyl-3-dimetyl-hydroxypropyl ammonium bromide (DORIE-HP), 1,2-dioleyl-oxy-propyl-3-dimethyl-hydroxybutyl ammonium bromide (DORIE-HB), 1,2-dioleyloxypropyl-3-dimethyl-hydroxypentyl ammonium bromide (DORIE-Hpe), 1,2-dimyristyloxypropyl-3-dimethyl-hydroxylethyl ammonium bromide (DMRIE), 1,2-dipalmityloxypropyl-3-dimethyl-hydroxyethyl ammonium bromide (DPRIE), and 1,2-disteryloxypropyl-3-dimethyl-hydroxyethyl ammonium bromide (DSRIE).

Suitable solid lipids include, but are not limited to, higher saturated alcohols, higher fatty acids, sphingolipids, synthetic esters, and mono-, di-, and triglycerides of higher saturated fatty acids. Solid lipids can include aliphatic alcohols having 10-40, for example, 12-30 carbon atoms, such as cetostearyl alcohol. Solid lipids can include higher fatty acids of 10-40, for example, 12-30 carbon atoms, such as stearic acid, palmitic acid, decanoic acid, and behenic acid. Solid lipids can include glycerides, including monoglycerides, diglycerides, and triglycerides, of higher saturated fatty acids having 10-40, for example, 12-30 carbon atoms, such as glyceryl monostearate, glycerol behenate, glycerol palmitostearate, glycerol trilaurate, tricaprin, trilaurin, trimyristin, tripalmitin, tristearin, and hydrogenated castor oil. Suitable solid lipids can include cetyl palmitate, beeswax, or cyclodextrin.

Amphiphilic compounds include, but are not limited to, phospholipids, such as 1,2 distearoyl-sn-glycero-3-phosphoethanolamine (DSPE), dipalmitoylphosphatidylcholine (DPPC), di stearoylphosphatidylcholine (DSPC), diarachidoylphosphatidylcholine (DAPC), dibehenoylphosphatidylcholine (DBPC), ditricosanoylphosphatidylcholine (DTPC), and dilignoceroylphatidylcholine (DLPC), incorporated at a ratio of between 0.01-60 (weight lipid/w polymer), for example, between 0.1-30 (weight lipid/w polymer). Phospholipids that may be used include, but are not limited to, phosphatidic acids, phosphatidyl cholines with both saturated and unsaturated lipids, phosphatidyl ethanolamines, phosphatidylglycerols, phosphatidylserines, phosphatidylinositols, lysophosphatidyl derivatives, cardiolipin, and β-acyl-γ-alkyl phospholipids. Examples of phospholipids include, but are not limited to, phosphatidylcholines such as dioleoylphosphatidylcholine, dimyristoylphosphatidylcholine, dipentadecanoylphosphatidylcholine dilauroylphosphatidylcholine, dipalmitoylphosphatidylcholine (DPPC), di stearoylphosphatidylcholine (DSPC), diarachidoylphosphatidylcholine (DAPC), dibehenoylphosphatidylcho-line (DBPC), ditricosanoylphosphatidylcholine (DTPC), dilignoceroylphatidylcholine (DLPC); and phosphatidylethanolamines such as dioleoylphosphatidylethanolamine or 1-hexadecyl-2-palmitoylglycerophos-phoethanolamine. Synthetic phospholipids with asymmetric acyl chains (e.g., with one acyl chain of 6 carbons and another acyl chain of 12 carbons) may also be used.

D. Additional Active Agents

The particles can contain one or more additional active agents in addition to those in the conjugates. The additional active agents can be therapeutic, prophylactic, diagnostic, or nutritional agents as listed above. The additional active agents can be present in any amount, e.g. from about 0.5% to about 90%, from about 0.5% to about 50%, from about 0.5% to about 25%, from about 0.5% to about 20%, from about 0.5% to about 10%, or from about 5% to about 10% (w/w) based upon the weight of the particle. In one embodiment, the agents are incorporated in an about 0.5% to about 10% loading w/w.

E. Additional Targeting Moieties

The particles can contain one or more targeting moieties targeting the particle to a specific organ, tissue, cell type, or subcellular compartment in addition to the targeting moieties of the conjugate. The additional targeting moieties can be present on the surface of the particle, on the interior of the particle, or both. The additional targeting moieties can be immobilized on the surface of the particle, e.g., can be covalently attached to polymer or lipid in the particle. In some embodiments, the additional targeting moieties are covalently attached to an amphiphilic polymer or a lipid such that the targeting moieties are oriented on the surface of the particle.

III. Formulations

In some embodiments, compositions are administered to humans, human patients or subjects. For the purposes of the present disclosure, the phrase “active ingredient” generally refers to the conjugate or particles comprising the conjugates to be delivered as described herein.

Although the descriptions of pharmaceutical compositions provided herein are principally directed to pharmaceutical compositions which are suitable for administration to humans, it will be understood by the skilled artisan that such compositions are generally suitable for administration to any other animal, e.g., to non-human animals, e.g. non-human mammals. Modification of pharmaceutical compositions suitable for administration to humans in order to render the compositions suitable for administration to various animals is well understood, and the ordinarily skilled veterinary pharmacologist can design and/or perform such modification with merely ordinary, if any, experimentation. Subjects to which administration of the pharmaceutical compositions is contemplated include, but are not limited to, humans and/or other primates; mammals, including commercially relevant mammals such as cattle, pigs, horses, sheep, cats, dogs, mice, and/or rats; and/or birds, including commercially relevant birds such as poultry, chickens, ducks, geese, and/or turkeys.

Formulations of the pharmaceutical compositions described herein may be prepared by any method known or hereafter developed in the art of pharmacology. In general, such preparatory methods include the step of bringing the active ingredient into association with an excipient and/or one or more other accessory ingredients, and then, if necessary and/or desirable, dividing, shaping and/or packaging the product into a desired single- or multi-dose unit.

A pharmaceutical composition in accordance with the invention may be prepared, packaged, and/or sold in bulk, as a single unit dose, and/or as a plurality of single unit doses. As used herein, a “unit dose” is discrete amount of the pharmaceutical composition comprising a predetermined amount of the active ingredient. The amount of the active ingredient is generally equal to the dosage of the active ingredient which would be administered to a subject and/or a convenient fraction of such a dosage such as, for example, one-half or one-third of such a dosage.

Relative amounts of the active ingredient, the pharmaceutically acceptable excipient, and/or any additional ingredients in a pharmaceutical composition in accordance with the invention will vary, depending upon the identity, size, and/or condition of the subject treated and further depending upon the route by which the composition is to be administered. By way of example, the composition may comprise between 0.1% and 100%, e.g., between 0.5 and 50%, between 1-30%, between 5-80%, at least 80% (w/w) active ingredient.

The conjugates or particles of the present invention can be formulated using one or more excipients to: (1) increase stability; (2) permit the sustained or delayed release (e.g., from a depot formulation of the monomaleimide); (3) alter the biodistribution (e.g., target the monomaleimide compounds to specific tissues or cell types); (4) alter the release profile of the monomaleimide compounds in vivo. Non-limiting examples of the excipients include any and all solvents, dispersion media, diluents, or other liquid vehicles, dispersion or suspension aids, surface active agents, isotonic agents, thickening or emulsifying agents, and preservatives. Excipients of the present invention may also include, without limitation, lipidoids, liposomes, lipid nanoparticles, polymers, lipoplexes, core-shell nanoparticles, peptides, proteins, hyaluronidase, nanoparticle mimics and combinations thereof. Accordingly, the formulations of the invention may include one or more excipients, each in an amount that together increases the stability of the monomaleimide compounds.

In some embodiments, the pharmaceutical composition comprises the conjugate of the present invention has a pH of about 4.0 to about 5.0. In some embodiments, the pharmaceutical composition comprises acetate buffer (sodium acetate and acetic acid) having a pH of about 4.0 to about 4.8. In some embodiments, the pharmaceutical composition further comprises mannitol and polyoxyl 15 hydroxystearate.

In one embodiment, a composition for solution for injection is provided. The solution comprises Conjugate 57, mannitol, Polyoxyl 15 Hydroxystearate, and aqueous acetate buffer. Each dosage unit contains 2.5 mg/mL of Conjugate 57 (free-base), 50 mg/mL mannitol, 20 mg/mL Polyoxyl 15 Hydroxystearate and pH 4.0-4.8 acetate buffer in a stoppered 10 mL clear glass vial. The clear glass vial is stopped with 20 mm FluroTec® gray lyo stoppers, and sealed with 20 mm dark blue flip-off seals. Prior to administration, the solution is diluted with 5% Mannitol Injection USP. The resulting diluted composition can be infused intravenously.

Excipients

Pharmaceutical formulations may additionally comprise a pharmaceutically acceptable excipient, which, as used herein, includes any and all solvents, dispersion media, diluents, or other liquid vehicles, dispersion or suspension aids, surface active agents, isotonic agents, thickening or emulsifying agents, preservatives, solid binders, lubricants and the like, as suited to the particular dosage form desired. Remington's The Science and Practice of Pharmacy, 21st Edition, A. R. Gennaro (Lippincott, Williams & Wilkins, Baltimore, Md., 2006; incorporated herein by reference in its entirety) discloses various excipients used in formulating pharmaceutical compositions and known techniques for the preparation thereof. Except insofar as any conventional excipient medium is incompatible with a substance or its derivatives, such as by producing any undesirable biological effect or otherwise interacting in a deleterious manner with any other component(s) of the pharmaceutical composition, its use is contemplated to be within the scope of this invention.

In some embodiments, a pharmaceutically acceptable excipient is at least 95%, at least 96%, at least 97%, at least 98%, at least 99%, or 100% pure. In some embodiments, an excipient is approved for use in humans and for veterinary use. In some embodiments, an excipient is approved by United States Food and Drug Administration. In some embodiments, an excipient is pharmaceutical grade. In some embodiments, an excipient meets the standards of the United States Pharmacopoeia (USP), the European Pharmacopoeia (EP), the British Pharmacopoeia, and/or the International Pharmacopoeia.

Pharmaceutically acceptable excipients used in the manufacture of pharmaceutical compositions include, but are not limited to, inert diluents, dispersing and/or granulating agents, surface active agents and/or emulsifiers, disintegrating agents, binding agents, preservatives, buffering agents, lubricating agents, and/or oils. Such excipients may optionally be included in pharmaceutical compositions.

Exemplary diluents include, but are not limited to, calcium carbonate, sodium carbonate, calcium phosphate, dicalcium phosphate, calcium sulfate, calcium hydrogen phosphate, sodium phosphate lactose, sucrose, cellulose, microcrystalline cellulose, kaolin, mannitol, sorbitol, inositol, sodium chloride, dry starch, cornstarch, powdered sugar, etc., and/or combinations thereof.

Exemplary granulating and/or dispersing agents include, but are not limited to, potato starch, corn starch, tapioca starch, sodium starch glycolate, clays, alginic acid, guar gum, citrus pulp, agar, bentonite, cellulose and wood products, natural sponge, cation-exchange resins, calcium carbonate, silicates, sodium carbonate, cross-linked poly(vinyl-pyrrolidone) (crospovidone), sodium carboxymethyl starch (sodium starch glycolate), carboxymethyl cellulose, cross-linked sodium carboxymethyl cellulose (croscarmellose), methylcellulose, pregelatinized starch (starch 1500), microcrystalline starch, water insoluble starch, calcium carboxymethyl cellulose, magnesium aluminum silicate (VEEGUM®), sodium lauryl sulfate, quaternary ammonium compounds, etc., and/or combinations thereof.

Exemplary surface active agents and/or emulsifiers include, but are not limited to, natural emulsifiers (e.g. acacia, agar, alginic acid, sodium alginate, tragacanth, chondrux, cholesterol, xanthan, pectin, gelatin, egg yolk, casein, wool fat, cholesterol, wax, and lecithin), colloidal clays (e.g. bentonite [aluminum silicate] and VEEGUM® [magnesium aluminum silicate]), long chain amino acid derivatives, high molecular weight alcohols (e.g. stearyl alcohol, cetyl alcohol, oleyl alcohol, triacetin monostearate, ethylene glycol distearate, glyceryl monostearate, and propylene glycol monostearate, polyvinyl alcohol), carbomers (e.g. carboxy polymethylene, polyacrylic acid, acrylic acid polymer, and carboxyvinyl polymer), carrageenan, cellulosic derivatives (e.g. carboxymethylcellulose sodium, powdered cellulose, hydroxymethyl cellulose, hydroxypropyl cellulose, hydroxypropyl methylcellulose, methylcellulose), sorbitan fatty acid esters (e.g. polyoxyethylene sorbitan monolaurate [TWEEN®20], polyoxyethylene sorbitan [TWEENn®60], polyoxyethylene sorbitan monooleate [TWEEN®80], sorbitan monopalmitate [SPAN®40], sorbitan monostearate [SPAN®60], sorbitan tristearate [SPAN®65], glyceryl monooleate, sorbitan monooleate [SPAN®80]), polyoxyethylene esters (e.g. polyoxyethylene monostearate [MYRJ®45], polyoxyethylene hydrogenated castor oil, polyethoxylated castor oil, polyoxymethylene stearate, and SOLUTOL®), sucrose fatty acid esters, polyethylene glycol fatty acid esters (e.g. CREMOPHOR®), polyoxyethylene ethers, (e.g. polyoxyethylene lauryl ether [BRIJ®30]), poly(vinyl-pyrrolidone), diethylene glycol monolaurate, triethanolamine oleate, sodium oleate, potassium oleate, ethyl oleate, oleic acid, ethyl laurate, sodium lauryl sulfate, PLUORINC®F 68, POLOXAMER®188, cetrimonium bromide, cetylpyridinium chloride, benzalkonium chloride, docusate sodium, etc. and/or combinations thereof.

Exemplary binding agents include, but are not limited to, starch (e.g. cornstarch and starch paste); gelatin; sugars (e.g. sucrose, glucose, dextrose, dextrin, molasses, lactose, lactitol, mannitol); natural and synthetic gums (e.g. acacia, sodium alginate, extract of Irish moss, panwar gum, ghatti gum, mucilage of isapol husks, carboxymethylcellulose, methylcellulose, ethylcellulose, hydroxyethylcellulose, hydroxypropyl cellulose, hydroxypropyl methylcellulose, microcrystalline cellulose, cellulose acetate, poly(vinyl-pyrrolidone), magnesium aluminum silicate (Veegum®), and larch arabogalactan); alginates; polyethylene oxide; polyethylene glycol; inorganic calcium salts; silicic acid; polymethacrylates; waxes; water; alcohol; etc.; and combinations thereof.

Exemplary preservatives may include, but are not limited to, antioxidants, chelating agents, antimicrobial preservatives, antifungal preservatives, alcohol preservatives, acidic preservatives, and/or other preservatives. Exemplary antioxidants include, but are not limited to, alpha tocopherol, ascorbic acid, acorbyl palmitate, butylated hydroxyanisole, butylated hydroxytoluene, monothioglycerol, potassium metabisulfite, propionic acid, propyl gallate, sodium ascorbate, sodium bisulfite, sodium metabisulfite, and/or sodium sulfite. Exemplary chelating agents include ethylenediaminetetraacetic acid (EDTA), citric acid monohydrate, disodium edetate, dipotassium edetate, edetic acid, fumaric acid, malic acid, phosphoric acid, sodium edetate, tartaric acid, and/or trisodium edetate. Exemplary antimicrobial preservatives include, but are not limited to, benzalkonium chloride, benzethonium chloride, benzyl alcohol, bronopol, cetrimide, cetylpyridinium chloride, chlorhexidine, chlorobutanol, chlorocresol, chloroxylenol, cresol, ethyl alcohol, glycerin, hexetidine, imidurea, phenol, phenoxyethanol, phenylethyl alcohol, phenylmercuric nitrate, propylene glycol, and/or thimerosal. Exemplary antifungal preservatives include, but are not limited to, butyl paraben, methyl paraben, ethyl paraben, propyl paraben, benzoic acid, hydroxybenzoic acid, potassium benzoate, potassium sorbate, sodium benzoate, sodium propionate, and/or sorbic acid. Exemplary alcohol preservatives include, but are not limited to, ethanol, polyethylene glycol, phenol, phenolic compounds, bisphenol, chlorobutanol, hydroxybenzoate, and/or phenylethyl alcohol. Exemplary acidic preservatives include, but are not limited to, vitamin A, vitamin C, vitamin E, beta-carotene, citric acid, acetic acid, dehydroacetic acid, ascorbic acid, sorbic acid, and/or phytic acid. Other preservatives include, but are not limited to, tocopherol, tocopherol acetate, deteroxime mesylate, cetrimide, butylated hydroxyanisol (BHA), butylated hydroxytoluened (BHT), ethylenediamine, sodium lauryl sulfate (SLS), sodium lauryl ether sulfate (SLES), sodium bisulfite, sodium metabisulfite, potassium sulfite, potassium metabisulfite, GLYDANT PLUS®, PHENONIP®, methylparaben, GERMALL®115, GERMABEN®II, NEOLONE™, KATHON™, and/or EUXYL®.

Exemplary buffering agents include, but are not limited to, citrate buffer solutions, acetate buffer solutions, phosphate buffer solutions, ammonium chloride, calcium carbonate, calcium chloride, calcium citrate, calcium glubionate, calcium gluceptate, calcium gluconate, D-gluconic acid, calcium glycerophosphate, calcium lactate, propanoic acid, calcium levulinate, pentanoic acid, dibasic calcium phosphate, phosphoric acid, tribasic calcium phosphate, calcium hydroxide phosphate, potassium acetate, potassium chloride, potassium gluconate, potassium mixtures, dibasic potassium phosphate, monobasic potassium phosphate, potassium phosphate mixtures, sodium acetate, sodium bicarbonate, sodium chloride, sodium citrate, sodium lactate, dibasic sodium phosphate, monobasic sodium phosphate, sodium phosphate mixtures, tromethamine, magnesium hydroxide, aluminum hydroxide, alginic acid, pyrogen-free water, isotonic saline, Ringer's solution, ethyl alcohol, etc., and/or combinations thereof.

Exemplary lubricating agents include, but are not limited to, magnesium stearate, calcium stearate, stearic acid, silica, talc, malt, glyceryl behanate, hydrogenated vegetable oils, polyethylene glycol, sodium benzoate, sodium acetate, sodium chloride, leucine, magnesium lauryl sulfate, sodium lauryl sulfate, etc., and combinations thereof.

Exemplary oils include, but are not limited to, almond, apricot kernel, avocado, babassu, bergamot, black current seed, borage, cade, camomile, canola, caraway, carnauba, castor, cinnamon, cocoa butter, coconut, cod liver, coffee, corn, cotton seed, emu, eucalyptus, evening primrose, fish, flaxseed, geraniol, gourd, grape seed, hazel nut, hyssop, isopropyl myristate, jojoba, kukui nut, lavandin, lavender, lemon, litsea cubeba, macademia nut, mallow, mango seed, meadowfoam seed, mink, nutmeg, olive, orange, orange roughy, palm, palm kernel, peach kernel, peanut, poppy seed, pumpkin seed, rapeseed, rice bran, rosemary, safflower, sandalwood, sasquana, savoury, sea buckthorn, sesame, shea butter, silicone, soybean, sunflower, tea tree, thistle, tsubaki, vetiver, walnut, and wheat germ oils. Exemplary oils include, but are not limited to, butyl stearate, caprylic triglyceride, capric triglyceride, cyclomethicone, diethyl sebacate, dimethicone 360, isopropyl myristate, mineral oil, octyldodecanol, oleyl alcohol, silicone oil, and/or combinations thereof.

Excipients such as cocoa butter and suppository waxes, coloring agents, coating agents, sweetening, flavoring, and/or perfuming agents can be present in the composition, according to the judgment of the formulator.

Administration

The conjugates or particles of the present invention may be administered by any route which results in a therapeutically effective outcome. These include, but are not limited to enteral, gastroenteral, epidural, oral, transdermal, epidural (peridural), intracerebral (into the cerebrum), intracerebroventricular (into the cerebral ventricles), epicutaneous (application onto the skin), intradermal, (into the skin itself), subcutaneous (under the skin), nasal administration (through the nose), intravenous (into a vein), intraarterial (into an artery), intramuscular (into a muscle), intracardiac (into the heart), intraosseous infusion (into the bone marrow), intrathecal (into the spinal canal), intraperitoneal, (infusion or injection into the peritoneum), intravesical infusion, intravitreal, (through the eye), intracavernous injection, (into the base of the penis), intravaginal administration, intrauterine, extra-amniotic administration, transdermal (diffusion through the intact skin for systemic distribution), transmucosal (diffusion through a mucous membrane), insufflation (snorting), sublingual, sublabial, enema, eye drops (onto the conjunctiva), or in ear drops. In specific embodiments, compositions may be administered in a way which allows them cross the blood-brain barrier, vascular barrier, or other epithelial barrier.

The formulations described herein contain an effective amount of conjugates or particles in a pharmaceutical carrier appropriate for administration to an individual in need thereof. The formulations may be administered parenterally (e.g., by injection or infusion). The formulations or variations thereof may be administered in any manner including enterally, topically (e.g., to the eye), or via pulmonary administration. In some embodiments the formulations are administered topically.

A. Parenteral Formulations

The conjugates or particles can be formulated for parenteral delivery, such as injection or infusion, in the form of a solution, suspension or emulsion. The formulation can be administered systemically, regionally or directly to the organ or tissue to be treated.

Parenteral formulations can be prepared as aqueous compositions using techniques is known in the art. Typically, such compositions can be prepared as injectable formulations, for example, solutions or suspensions; solid forms suitable for using to prepare solutions or suspensions upon the addition of a reconstitution medium prior to injection; emulsions, such as water-in-oil (w/o) emulsions, oil-in-water (o/w) emulsions, and microemulsions thereof, liposomes, or emulsomes.

The carrier can be a solvent or dispersion medium containing, for example, water, ethanol, one or more polyols (e.g., glycerol, propylene glycol, and liquid polyethylene glycol), oils, such as vegetable oils (e.g., peanut oil, corn oil, sesame oil, etc.), and combinations thereof. The proper fluidity can be maintained, for example, by the use of a coating, such as lecithin, by the maintenance of the required particle size in the case of dispersion and/or by the use of surfactants. In some cases, an isotonic agent is included, for example, one or more sugars, sodium chloride, or other suitable agent known in the art.

Solutions and dispersions of the conjugates or particles can be prepared in water or another solvent or dispersing medium suitably mixed with one or more pharmaceutically acceptable excipients including, but not limited to, surfactants, dispersants, emulsifiers, pH modifying agents, and combinations thereof.

Suitable surfactants may be anionic, cationic, amphoteric or nonionic surface active agents. Suitable anionic surfactants include, but are not limited to, those containing carboxylate, sulfonate and sulfate ions. Examples of anionic surfactants include sodium, potassium, ammonium of long chain alkyl sulfonates and alkyl aryl sulfonates such as sodium dodecylbenzene sulfonate; dialkyl sodium sulfosuccinates, such as sodium dodecylbenzene sulfonate; dialkyl sodium sulfosuccinates, such as sodium bis-(2-ethylthioxyl)-sulfosuccinate; and alkyl sulfates such as sodium lauryl sulfate. Cationic surfactants include, but are not limited to, quaternary ammonium compounds such as benzalkonium chloride, benzethonium chloride, cetrimonium bromide, stearyl dimethylbenzyl ammonium chloride, polyoxyethylene and coconut amine. Examples of nonionic surfactants include ethylene glycol monostearate, propylene glycol myristate, glyceryl monostearate, glyceryl stearate, polyglyceryl-4-oleate, sorbitan acylate, sucrose acylate, PEG-1501aurate, PEG-400 monolaurate, polyoxyethylene monolaurate, polysorbates, polyoxyethylene octylphenylether, PEG-1000 cetyl ether, polyoxyethylene tridecyl ether, polypropylene glycol butyl ether, Poloxamer® 401, stearoyl monoisopropanolamide, and polyoxyethylene hydrogenated tallow amide. Examples of amphoteric surfactants include sodium N-dodecyl-β-alanine, sodium N-lauryl-β-iminodipropionate, myristoamphoacetate, lauryl betaine and lauryl sulfobetaine.

The formulation can contain a preservative to prevent the growth of microorganisms. Suitable preservatives include, but are not limited to, parabens, chlorobutanol, phenol, sorbic acid, and thimerosal. The formulation may also contain an antioxidant to prevent degradation of the active agent(s) or particles.

The formulation is typically buffered to a pH of 3-8 for parenteral administration upon reconstitution. Suitable buffers include, but are not limited to, phosphate buffers, acetate buffers, and citrate buffers. If using 10% sucrose or 5% dextrose, a buffer may not be required.

Water soluble polymers are often used in formulations for parenteral administration. Suitable water-soluble polymers include, but are not limited to, polyvinylpyrrolidone, dextran, carboxymethylcellulose, and polyethylene glycol.

Sterile injectable solutions can be prepared by incorporating the conjugates or particles in the required amount in the appropriate solvent or dispersion medium with one or more of the excipients listed above, as required, followed by filtered sterilization. Generally, dispersions are prepared by incorporating the various sterilized conjugates or particles into a sterile vehicle which contains the basic dispersion medium and the required other ingredients from those listed above. In the case of sterile powders for the preparation of sterile injectable solutions, examples of methods of preparation include vacuum-drying and freeze-drying techniques that yield a powder of the particle plus any additional desired ingredient from a previously sterile-filtered solution thereof. The powders can be prepared in such a manner that the particles are porous in nature, which can increase dissolution of the particles. Methods for making porous particles are known in the art.

Pharmaceutical formulations for parenteral administration can be in the form of a sterile aqueous solution or suspension of conjugates or particles formed from one or more polymer-drug conjugates. Acceptable solvents include, for example, water, Ringer's solution, phosphate buffered saline (PBS), and isotonic sodium chloride solution. The formulation may also be a sterile solution, suspension, or emulsion in a nontoxic, parenterally acceptable diluent or solvent such as 1,3-butanediol.

In some instances, the formulation is distributed or packaged in a liquid form. Alternatively, formulations for parenteral administration can be packed as a solid, obtained, for example by lyophilization of a suitable liquid formulation. The solid can be reconstituted with an appropriate carrier or diluent prior to administration.

Solutions, suspensions, or emulsions for parenteral administration may be buffered with an effective amount of buffer necessary to maintain a pH suitable for ocular administration. Suitable buffers are well known by those skilled in the art and some examples of useful buffers are acetate, borate, carbonate, citrate, and phosphate buffers.

Solutions, suspensions, or emulsions for parenteral administration may also contain one or more tonicity agents to adjust the isotonic range of the formulation. Suitable tonicity agents are well known in the art and some examples include glycerin, sucrose, dextrose, mannitol, sorbitol, sodium chloride, and other electrolytes.

Solutions, suspensions, or emulsions for parenteral administration may also contain one or more preservatives to prevent bacterial contamination of the ophthalmic preparations. Suitable preservatives are known in the art, and include polyhexamethylenebiguanidine (PHMB), benzalkonium chloride (BAK), stabilized oxychloro complexes (otherwise known as Purite®), phenylmercuric acetate, chlorobutanol, sorbic acid, chlorhexidine, benzyl alcohol, parabens, thimerosal, and mixtures thereof.

Solutions, suspensions, or emulsions for parenteral administration may also contain one or more excipients known art, such as dispersing agents, wetting agents, and suspending agents.

B. Mucosal Topical Formulations

The conjugates or particles can be formulated for topical administration to a mucosal surface Suitable dosage forms for topical administration include creams, ointments, salves, sprays, gels, lotions, emulsions, liquids, and transdermal patches. The formulation may be formulated for transmucosal transepithelial, or transendothelial administration. The compositions contain one or more chemical penetration enhancers, membrane permeability agents, membrane transport agents, emollients, surfactants, stabilizers, and combination thereof. In some embodiments, the conjugates or particles can be administered as a liquid formulation, such as a solution or suspension, a semi-solid formulation, such as a lotion or ointment, or a solid formulation. In some embodiments, the conjugates or particles are formulated as liquids, including solutions and suspensions, such as eye drops or as a semi-solid formulation, to the mucosa, such as the eye or vaginally or rectally.

“Surfactants” are surface-active agents that lower surface tension and thereby increase the emulsifying, foaming, dispersing, spreading and wetting properties of a product. Suitable non-ionic surfactants include emulsifying wax, glyceryl monooleate, polyoxyethylene alkyl ethers, polyoxyethylene castor oil derivatives, polysorbate, sorbitan esters, benzyl alcohol, benzyl benzoate, cyclodextrins, glycerin monostearate, poloxamer, povidone and combinations thereof. In one embodiment, the non-ionic surfactant is stearyl alcohol.

“Emulsifiers” are surface active substances which promote the suspension of one liquid in another and promote the formation of a stable mixture, or emulsion, of oil and water. Common emulsifiers are: metallic soaps, certain animal and vegetable oils, and various polar compounds. Suitable emulsifiers include acacia, anionic emulsifying wax, calcium stearate, carbomers, cetostearyl alcohol, cetyl alcohol, cholesterol, diethanolamine, ethylene glycol palmitostearate, glycerin monostearate, glyceryl monooleate, hydroxpropyl cellulose, hypromellose, lanolin, hydrous, lanolin alcohols, lecithin, medium-chain triglycerides, methylcellulose, mineral oil and lanolin alcohols, monobasic sodium phosphate, monoethanolamine, nonionic emulsifying wax, oleic acid, poloxamer, poloxamers, polyoxyethylene alkyl ethers, polyoxyethylene castor oil derivatives, polyoxyethylene sorbitan fatty acid esters, polyoxyethylene stearates, propylene glycol alginate, self-emulsifying glyceryl monostearate, sodium citrate dehydrate, sodium lauryl sulfate, sorbitan esters, stearic acid, sunflower oil, tragacanth, triethanolamine, xanthan gum and combinations thereof. In one embodiment, the emulsifier is glycerol stearate.

Suitable classes of penetration enhancers are known in the art and include, but are not limited to, fatty alcohols, fatty acid esters, fatty acids, fatty alcohol ethers, amino acids, phospholipids, lecithins, cholate salts, enzymes, amines and amides, complexing agents (liposomes, cyclodextrins, modified celluloses, and diimides), macrocyclics, such as macrocylic lactones, ketones, and anhydrides and cyclic ureas, surfactants, N-methyl pyrrolidones and derivatives thereof, DMSO and related compounds, ionic compounds, azone and related compounds, and solvents, such as alcohols, ketones, amides, polyols (e.g., glycols). Examples of these classes are known in the art.

Dosing

The present invention provides methods comprising administering conjugates or particles containing the conjugate as described herein to a subject in need thereof. Conjugates or particles containing the conjugates as described herein may be administered to a subject using any amount and any route of administration effective for preventing or treating or imaging a disease, disorder, and/or condition (e.g., a disease, disorder, and/or condition relating to working memory deficits). The exact amount required will vary from subject to subject, depending on the species, age, and general condition of the subject, the severity of the disease, the particular composition, its mode of administration, its mode of activity, and the like.

Compositions in accordance with the invention are typically formulated in dosage unit form for ease of administration and uniformity of dosage. It will be understood, however, that the total daily usage of the compositions of the present invention may be decided by the attending physician within the scope of sound medical judgment. The specific therapeutically effective, prophylactically effective, or appropriate imaging dose level for any particular patient will depend upon a variety of factors including the disorder being treated and the severity of the disorder; the activity of the specific compound employed; the specific composition employed; the age, body weight, general health, sex and diet of the patient; the time of administration, route of administration, and rate of excretion of the specific compound employed; the duration of the treatment; drugs used in combination or coincidental with the specific compound employed; and like factors well known in the medical arts.

In some embodiments, compositions in accordance with the present invention may be administered at dosage levels sufficient to deliver from about 0.0001 mg/kg to about 100 mg/kg, from about 0.001 mg/kg to about 0.05 mg/kg, from about 0.005 mg/kg to about 0.05 mg/kg, from about 0.001 mg/kg to about 0.005 mg/kg, from about 0.05 mg/kg to about 0.5 mg/kg, from about 0.01 mg/kg to about 50 mg/kg, from about 0.1 mg/kg to about 40 mg/kg, from about 0.5 mg/kg to about 30 mg/kg, from about 0.01 mg/kg to about 10 mg/kg, from about 0.1 mg/kg to about 10 mg/kg, or from about 1 mg/kg to about 25 mg/kg, of subject body weight per day, one or more times a day, to obtain the desired therapeutic, diagnostic, prophylactic, or imaging effect. The desired dosage may be delivered three times a day, two times a day, once a day, every other day, every third day, every week, every two weeks, every three weeks, or every four weeks. In some embodiments, the desired dosage may be delivered using multiple administrations (e.g., two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, or more administrations). When multiple administrations are employed, split dosing regimens such as those described herein may be used.

In some embodiments, Conjugate 57 and/or its pharmaceutically acceptable salt is administered at a dosage of between about 1 mg to about 50 mg, such as about 1 mg, 2 mg, 4 mg, 6 mg, 8 mg, 10 mg, 12 mg, 14 mg, 16 mg, 18 mg, 20 mg, 22 mg, 24 mg, 26 mg, 28 mg, 30 mg, 32 mg, 34 mg, 36 mg, 38 mg, 40 mg, 42 mg, 44 mg, 46 mg, 48 mg, or 50 mg. In some embodiments, Conjugate 57 and/or its pharmaceutically acceptable salt is administered at a dosage of from about 18 mg to about 50 mg or about 25 mg to about 50 mg. In some embodiments, Conjugate 57 and/or its pharmaceutically acceptable salt is administered at a dosage of about 25 mg. In some embodiments, Conjugate 57 and/or its pharmaceutically acceptable salt is administered at a dosage of 25 mg.

The concentration of the conjugates or particles of the present invention may be between about 0.01 mg/mL to about 50 mg/mL, about 0.1 mg/mL to about 25 mg/mL, about 0.5 mg/mL to about 10 mg/mL, or about 1 mg/mL to about 5 mg/mL in the pharmaceutical composition.

As used herein, a “split dose” is the division of single unit dose or total daily dose into two or more doses, e.g, two or more administrations of the single unit dose. As used herein, a “single unit dose” is a dose of any therapeutic administered in one dose/at one time/single route/single point of contact, i.e., single administration event. As used herein, a “total daily dose” is an amount given or prescribed in 24 hr period. It may be administered as a single unit dose. In one embodiment, the monomaleimide compounds of the present invention are administered to a subject in split doses. The monomaleimide compounds may be formulated in buffer only or in a formulation described herein.

Dosage Forms

A pharmaceutical composition described herein can be formulated into a dosage form described herein, such as a topical, intranasal, intratracheal, or injectable (e.g., intravenous, intraocular, intravitreal, intramuscular, intracardiac, intraperitoneal, subcutaneous).

Liquid Dosage Forms

Liquid dosage forms for parenteral administration include, but are not limited to, pharmaceutically acceptable emulsions, microemulsions, solutions, suspensions, syrups, and/or elixirs. In addition to active ingredients, liquid dosage forms may comprise inert diluents commonly used in the art including, but not limited to, water or other solvents, solubilizing agents and emulsifiers such as ethyl alcohol, isopropyl alcohol, ethyl carbonate, ethyl acetate, benzyl alcohol, benzyl benzoate, propylene glycol, 1,3-butylene glycol, dimethylformamide, oils (in particular, cottonseed, groundnut, corn, germ, olive, castor, and sesame oils), glycerol, tetrahydrofurfuryl alcohol, polyethylene glycols and fatty acid esters of sorbitan, and mixtures thereof. In certain embodiments for parenteral administration, compositions may be mixed with solubilizing agents such as CREMOPHOR®, alcohols, oils, modified oils, glycols, polysorbates, cyclodextrins, polymers, and/or combinations thereof.

Injectable

Injectable preparations, for example, sterile injectable aqueous or oleaginous suspensions may be formulated according to the known art and may include suitable dispersing agents, wetting agents, and/or suspending agents. Sterile injectable preparations may be sterile injectable solutions, suspensions, and/or emulsions in nontoxic parenterally acceptable diluents and/or solvents, for example, a solution in 1,3-butanediol. Among the acceptable vehicles and solvents that may be employed include, but are not limited to, water, Ringer's solution, U.S.P., and isotonic sodium chloride solution. Sterile, fixed oils are conventionally employed as a solvent or suspending medium. For this purpose any bland fixed oil can be employed including synthetic mono- or diglycerides. Fatty acids such as oleic acid can be used in the preparation of injectables.

Injectable formulations can be sterilized, for example, by filtration through a bacterial-retaining filter, and/or by incorporating sterilizing agents in the form of sterile solid compositions which can be dissolved or dispersed in sterile water or other sterile injectable medium prior to use.

In order to prolong the effect of an active ingredient, it may be desirable to slow the absorption of the active ingredient from subcutaneous or intramuscular injection. This may be accomplished by the use of a liquid suspension of crystalline or amorphous material with poor water solubility. The rate of absorption of the monomaleimide compounds then depends upon its rate of dissolution which, in turn, may depend upon crystal size and crystalline form. Alternatively, delayed absorption of a parenterally administered monomaleimide compound may be accomplished by dissolving or suspending the monomalimide in an oil vehicle. Injectable depot forms are made by forming microencapsule matrices of the monomaleimide compounds in biodegradable polymers such as polylactide-polyglycolide. Depending upon the ratio of monomaleimide compounds to polymer and the nature of the particular polymer employed, the rate of monomaleimide compound release can be controlled. Examples of other biodegradable polymers include, but are not limited to, poly(orthoesters) and poly(anhydrides). Depot injectable formulations may be prepared by entrapping the monomaleimide compounds in liposomes or microemulsions which are compatible with body tissues.

Pulmonary

Formulations described herein as being useful for pulmonary delivery may also be used for intranasal delivery of a pharmaceutical composition. Another formulation suitable for intranasal administration may be a coarse powder comprising the active ingredient and having an average particle from about 0.2 μm to 500 μm. Such a formulation may be administered in the manner in which snuff is taken, i.e. by rapid inhalation through the nasal passage from a container of the powder held close to the nose.

Formulations suitable for nasal administration may, for example, comprise from about as little as 0.1% (w/w) and as much as 100% (w/w) of active ingredient, and may comprise one or more of the additional ingredients described herein. A pharmaceutical composition may be prepared, packaged, and/or sold in a formulation suitable for buccal administration. Such formulations may, for example, be in the form of tablets and/or lozenges made using conventional methods, and may, for example, contain about 0.1% to 20% (w/w) active ingredient, where the balance may comprise an orally dissolvable and/or degradable composition and, optionally, one or more of the additional ingredients described herein. Alternately, formulations suitable for buccal administration may comprise a powder and/or an aerosolized and/or atomized solution and/or suspension comprising active ingredient. Such powdered, aerosolized, and/or aerosolized formulations, when dispersed, may have an average particle and/or droplet size in the range from about 0.1 nm to about 200 nm, and may further comprise one or more of any additional ingredients described herein.

General considerations in the formulation and/or manufacture of pharmaceutical agents may be found, for example, in Remington: The Science and Practice of Pharmacy 21st ed., Lippincott Williams & Wilkins, 2005 (incorporated herein by reference in its entirety).

Coatings or Shells

Solid dosage forms of tablets, dragees, capsules, pills, and granules can be prepared with coatings and shells such as enteric coatings and other coatings well known in the pharmaceutical formulating art. They may optionally comprise opacifying agents and can be of a composition that they release the active ingredient(s) only, or preferentially, in a certain part of the intestinal tract, optionally, in a delayed manner. Examples of embedding compositions which can be used include polymeric substances and waxes. Solid compositions of a similar type may be employed as fillers in soft and hard-filled gelatin capsules using such excipients as lactose or milk sugar as well as high molecular weight polyethylene glycols and the like.

IV. Methods of Making Particles

In various embodiments, a method of making the particles includes providing a conjugate; providing a base component such as PLA-PEG or PLGA-PEG for forming a particle; combining the conjugate and the base component in an organic solution to form a first organic phase; and combining the first organic phase with a first aqueous solution to form a second phase; emulsifying the second phase to form an emulsion phase; and recovering particles. In various embodiments, the emulsion phase is further homogenized.

In some embodiments, the first phase includes about 5 to about 50% weight, e.g. about 1 to about 40% solids, or about 5 to about 30% solids, e.g. about 5%, 10%, 15%, and 20%, of the conjugate and the base component. In certain embodiments, the first phase includes about 5% weight of the conjugate and the base component. In various embodiments, the organic phase comprises acetonitrile, tetrahydrofuran, ethyl acetate, isopropyl alcohol, isopropyl acetate, dimethylformamide, methylene chloride, dichloromethane, chloroform, acetone, benzyl alcohol, TWEEN® 80, SPAN® 80, or a combination thereof. In some embodiments, the organic phase includes benzyl alcohol, ethyl acetate, or a combination thereof.

In various embodiments, the aqueous solution includes water, sodium cholate, ethyl acetate, or benzyl alcohol. In various embodiments, a surfactant is added into the first phase, the second phase, or both. A surfactant, in some instances, can act as an emulsifier or a stabilizer for a composition disclosed herein. A suitable surfactant can be a cationic surfactant, an anionic surfactant, or a nonionic surfactant. In some embodiments, a surfactant suitable for making a composition described herein includes sorbitan fatty acid esters, polyoxyethylene sorbitan fatty acid esters and polyoxyethylene stearates. Examples of such fatty acid ester nonionic surfactants are the TWEEN® 80, SPAN® 80, and MYJ® surfactants from ICI. SPAN® surfactants include C₁₂-C₁₈ sorbitan monoesters. TWEEN® surfactants include poly(ethylene oxide) C₁₂-C₁₈ sorbitan monoesters. MYJ® surfactants include poly(ethylene oxide) stearates. In certain embodiments, the aqueous solution also comprises a surfactant (e.g., an emulsifier), including a polysorbate. For example, the aqueous solution can include polysorbate 80. In some embodiments, a suitable surfactant includes a lipid-based surfactant. For example, the composition can include 1,2-dihexanoyl-sn-glycero-3-phosphocholine, 1,2-diheptanoyl-sn-glycero-3-phosphocholine, PEGlyated 1,2-distearoyl-sn-glycero-3-phosphoethanolamine (including PEG5000-DSPE), PEGlyated 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine (including 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine-N-[methoxy(polyethylene glycol)-5000] (ammonium salt)).

Emulsifying the second phase to form an emulsion phase may be performed in one or two emulsification steps. For example, a primary emulsion may be prepared, and then emulsified to form a fine emulsion. The primary emulsion can be formed, for example, using simple mixing, a high pressure homogenizer, probe sonicator, stir bar, or a rotor stator homogenizer. The primary emulsion may be formed into a fine emulsion through the use of e.g. a probe sonicator or a high pressure homogenizer, e.g. by pass(es) through a homogenizer. For example, when a high pressure homogenizer is used, the pressure used may be about 4000 to about 8000 psi, about 4000 to about 5000 psi, or 4000 or 5000 psi.

Either solvent evaporation or dilution may be needed to complete the extraction of the solvent and solidify the particles. For better control over the kinetics of extraction and a more scalable process, a solvent dilution via aqueous quench may be used. For example, the emulsion can be diluted into cold water to a concentration sufficient to dissolve all of the organic solvent to form a quenched phase. Quenching may be performed at least partially at a temperature of about 5° C. or less. For example, water used in the quenching may be at a temperature that is less that room temperature (e.g. about 0 to about 10° C., or about 0 to about 5° C.).

In various embodiments, the particles are recovered by filtration. For example, ultrafiltration membranes can be used. Exemplary filtration may be performed using a tangential flow filtration system. For example, by using a membrane with a pore size suitable to retain particles while allowing solutes, micelles, and organic solvent to pass, particles can be selectively separated. Exemplary membranes with molecular weight cut-offs of about 300-500 kDa (˜5-25 nm) may be used.

In various embodiments, the particles are freeze-dried or lyophilized, in some instances, to extend their shelf life. In some embodiments, the composition also includes a lyoprotectant. In certain embodiments, a lyoprotectant is selected from a sugar, a polyalcohol, or a derivative thereof. In some embodiments, a lyoprotectant is selected from a monosaccharide, a disaccharide, or a mixture thereof. For example, a lyoprotectant can be sucrose, lactulose, trehalose, lactose, glucose, maltose, mannitol, cellobiose, or a mixture thereof.

Methods of making particles containing one or more conjugates are provided. The particles can be polymeric particles, lipid particles, or combinations thereof. The various methods described herein can be adjusted to control the size and composition of the particles, e.g. some methods are best suited for preparing microparticles while others are better suited for preparing particles. The selection of a method for preparing particles having the descried characteristics can be performed by the skilled artisan without undue experimentation.

i. Polymeric Particles

Methods of making polymeric particles are known in the art. Polymeric particles can be prepared using any suitable method known in the art. Common microencapsulation techniques include, but are not limited to, spray drying, interfacial polymerization, hot melt encapsulation, phase separation encapsulation (spontaneous emulsion microencapsulation, solvent evaporation microencapsulation, and solvent removal microencapsulation), coacervation, low temperature microsphere formation, and phase inversion nanoencapsulation (PIN). A brief summary of these methods is presented below.

1. Spray Drying

Methods for forming polymeric particles using spray drying techniques are described in U.S. Pat. No. 6,620,617. In this method, the polymer is dissolved in an organic solvent such as methylene chloride or in water. A known amount of one or more conjugates or additional active agents to be incorporated in the particles is suspended (in the case of an insoluble active agent) or co-dissolved (in the case of a soluble active agent) in the polymer solution. The solution or dispersion is pumped through a micronizing nozzle driven by a flow of compressed gas, and the resulting aerosol is suspended in a heated cyclone of air, allowing the solvent to evaporate from the microdroplets, forming particles. Microspheres/nanospheres ranging between 0.1 10 microns can be obtained using this method.

2. Interfacial Polymerization

Interfacial polymerization can also be used to encapsulate one or more conjugates and/or active agents. Using this method, a monomer and the conjugates or active agent(s) are dissolved in a solvent. A second monomer is dissolved in a second solvent (typically aqueous) which is immiscible with the first. An emulsion is formed by suspending the first solution through stirring in the second solution. Once the emulsion is stabilized, an initiator is added to the aqueous phase causing interfacial polymerization at the interface of each droplet of emulsion.

3. Hot Melt Microencapsulation

Microspheres can be formed from polymers such as polyesters and polyanhydrides using hot melt microencapsulation methods as described in Mathiowitz et al., Reactive Polymers, 6:275 (1987). In some embodiments employing this method, polymers with molecular weights between 3,000-75,000 daltons are used. In this method, the polymer first is melted and then mixed with the solid particles of one or more active agents to be incorporated that have been sieved to less than 50 microns. The mixture is suspended in a non-miscible solvent (like silicon oil), and, with continuous stirring, heated to 5° C. above the melting point of the polymer. Once the emulsion is stabilized, it is cooled until the polymer particles solidify. The resulting microspheres are washed by decanting with petroleum ether to produce a free flowing powder.

4. Phase Separation Microencapsulation

In phase separation microencapsulation techniques, a polymer solution is stirred, optionally in the presence of one or more active agents to be encapsulated. While continuing to uniformly suspend the material through stirring, a nonsolvent for the polymer is slowly added to the solution to decrease the polymer's solubility. Depending on the solubility of the polymer in the solvent and nonsolvent, the polymer either precipitates or phase separates into a polymer rich and a polymer poor phase. Under proper conditions, the polymer in the polymer rich phase will migrate to the interface with the continuous phase, encapsulating the active agent(s) in a droplet with an outer polymer shell.

a. Spontaneous Emulsion Microencapsulation

Spontaneous emulsification involves solidifying emulsified liquid polymer droplets formed above by changing temperature, evaporating solvent, or adding chemical cross-linking agents. The physical and chemical properties of the encapsulant, as well as the properties of the one or more active agents optionally incorporated into the nascent particles, dictates suitable methods of encapsulation. Factors such as hydrophobicity, molecular weight, chemical stability, and thermal stability affect encapsulation.

b. Solvent Evaporation Microencapsulation

Methods for forming microspheres using solvent evaporation techniques are described in Mathiowitz et al., J. Scanning Microscopy, 4:329 (1990); Beck et al., Fertil. Steril., 31:545 (1979); Beck et al., Am. J. Obstet. Gynecol. 135(3) (1979); Benita et al., J. Pharm. Sci., 73:1721 (1984); and U.S. Pat. No. 3,960,757. The polymer is dissolved in a volatile organic solvent, such as methylene chloride. One or more active agents to be incorporated are optionally added to the solution, and the mixture is suspended in an aqueous solution that contains a surface active agent such as poly(vinyl alcohol). The resulting emulsion is stirred until most of the organic solvent evaporated, leaving solid microparticles/nanoparticles. This method is useful for relatively stable polymers like polyesters and polystyrene.

c. Solvent Removal Microencapsulation

The solvent removal microencapsulation technique is primarily designed for polyanhydrides and is described, for example, in WO 93/21906. In this method, the substance to be incorporated is dispersed or dissolved in a solution of the selected polymer in a volatile organic solvent, such as methylene chloride. This mixture is suspended by stirring in an organic oil, such as silicon oil, to form an emulsion. Microspheres that range between 1-300 microns can be obtained by this procedure. Substances which can be incorporated in the microspheres include pharmaceuticals, pesticides, nutrients, imaging agents, and metal compounds.

5. Coacervation

Encapsulation procedures for various substances using coacervation techniques are known in the art, for example, in GB-B-929 406; GB-B-929 40 1; and U.S. Pat. Nos. 3,266,987, 4,794,000, and 4,460,563. Coacervation involves the separation of a macromolecular solution into two immiscible liquid phases. One phase is a dense coacervate phase, which contains a high concentration of the polymer encapsulant (and optionally one or more active agents), while the second phase contains a low concentration of the polymer. Within the dense coacervate phase, the polymer encapsulant forms nanoscale or microscale droplets. Coacervation may be induced by a temperature change, addition of a non-solvent or addition of a micro-salt (simple coacervation), or by the addition of another polymer thereby forming an interpolymer complex (complex coacervation).

6. Low Temperature Casting of Microspheres

Methods for very low temperature casting of controlled release particles are described in U.S. Pat. No. 5,019,400. In this method, a polymer is dissolved in a solvent optionally with one or more dissolved or dispersed active agents. The mixture is then atomized into a vessel containing a liquid non solvent at a temperature below the freezing point of the polymer substance solution which freezes the polymer droplets. As the droplets and non solvent for the polymer are warmed, the solvent in the droplets thaws and is extracted into the non solvent, resulting in the hardening of the microspheres.

7. Phase Inversion Nanoencapsulation (PIN)

Particles can also be formed using the phase inversion nanoencapsulation (PIN) method, wherein a polymer is dissolved in a “good” solvent, fine particles of a substance to be incorporated, such as a drug, are mixed or dissolved in the polymer solution, and the mixture is poured into a strong non solvent for the polymer, to spontaneously produce, under favorable conditions, polymeric microspheres, wherein the polymer is either coated with the particles or the particles are dispersed in the polymer. See, e.g., U.S. Pat. No. 6,143,211. The method can be used to produce monodisperse populations of nanoparticles and microparticles in a wide range of sizes, including, for example, about 100 nanometers to about 10 microns.

Advantageously, an emulsion need not be formed prior to precipitation. The process can be used to form microspheres from thermoplastic polymers.

8. Emulsion Methods

In some embodiments, a particle is prepared using an emulsion solvent evaporation method. For example, a polymeric material is dissolved in a water immiscible organic solvent and mixed with a drug solution or a combination of drug solutions. In some embodiments a solution of a therapeutic, prophylactic, or diagnostic agent to be encapsulated is mixed with the polymer solution. The polymer can be, but is not limited to, one or more of the following: PLA, PGA, PCL, their copolymers, polyacrylates, the aforementioned PEGylated polymers. The drug molecules can include one or more conjugates as described above and one or more additional active agents. The water immiscible organic solvent, can be, but is not limited to, one or more of the following: chloroform, dichloromethane, and acyl acetate. The drug can be dissolved in, but is not limited to, one or more of the following: acetone, ethanol, methanol, isopropyl alcohol, acetonitrile and Dimethyl sulfoxide (DMSO).

An aqueous solution is added into the resulting polymer solution to yield emulsion solution by emulsification. The emulsification technique can be, but not limited to, probe sonication or homogenization through a homogenizer.

9. Nanoprecipitation

In another embodiment, a conjugate containing nanoparticle is prepared using nanoprecipitation methods or microfluidic devices. The conjugate containing polymeric material is mixed with a drug or drug combinations in a water miscible organic solvent, optionally containing additional polymers. The additional polymer can be, but is not limited to, one or more of the following: PLA, PGA, PCL, their copolymers, polyacrylates, the aforementioned PEGylated polymers. The water miscible organic solvent, can be, but is not limited to, one or more of the following: acetone, ethanol, methanol, isopropyl alcohol, acetonitrile and dimethyl sulfoxide (DMSO). The resulting mixture solution is then added to a polymer non-solvent, such as an aqueous solution, to yield nanoparticle solution.

10. Microfluidics

Methods of making particles using microfluidics are known in the art. Suitable methods include those described in U.S. Patent Application Publication No. 2010/0022680 A1. In general, the microfluidic device comprises at least two channels that converge into a mixing apparatus. The channels are typically formed by lithography, etching, embossing, or molding of a polymeric surface. A source of fluid is attached to each channel, and the application of pressure to the source causes the flow of the fluid in the channel. The pressure may be applied by a syringe, a pump, and/or gravity. The inlet streams of solutions with polymer, targeting moieties, lipids, drug, payload, etc. converge and mix, and the resulting mixture is combined with a polymer non-solvent solution to form the particles having the desired size and density of moieties on the surface. By varying the pressure and flow rate in the inlet channels and the nature and composition of the fluid sources particles can be produced having reproducible size and structure.

ii. Lipid Particles

Methods of making lipid particles are known in the art. Lipid particles can be lipid micelles, liposomes, or solid lipid particles prepared using any suitable method known in the art. Common techniques for created lipid particles encapsulating an active agent include, but are not limited to high pressure homogenization techniques, supercritical fluid methods, emulsion methods, solvent diffusion methods, and spray drying. A brief summary of these methods is presented below.

1. High Pressure Homogenization (HPH) Methods

High pressure homogenization is a reliable and powerful technique, which is used for the production of smaller lipid particles with narrow size distributions, including lipid micelles, liposomes, and solid lipid particles. High pressure homogenizers push a liquid with high pressure (100-2000 bar) through a narrow gap (in the range of a few microns). The fluid can contain lipids that are liquid at room temperature or a melt of lipids that are solid at room temperature. The fluid accelerates on a very short distance to very high velocity (over 1000 Km/h). This creates high shear stress and cavitation forces that disrupt the particles, generally down to the submicron range. Generally 5-10% lipid content is used but up to 40% lipid content has also been investigated.

Two approaches of HPH are hot homogenization and cold homogenization, work on the same concept of mixing the drug in bulk of lipid solution or melt.

a. Hot Homogenization:

Hot homogenization is carried out at temperatures above the melting point of the lipid and can therefore be regarded as the homogenization of an emulsion. A pre-emulsion of the drug loaded lipid melt and the aqueous emulsifier phase is obtained by a high-shear mixing. HPH of the pre-emulsion is carried out at temperatures above the melting point of the lipid. A number of parameters, including the temperature, pressure, and number of cycles, can be adjusted to produce lipid particles with the desired size. In general, higher temperatures result in lower particle sizes due to the decreased viscosity of the inner phase. However, high temperatures increase the degradation rate of the drug and the carrier. Increasing the homogenization pressure or the number of cycles often results in an increase of the particle size due to high kinetic energy of the particles.

b. Cold Homogenization

Cold homogenization has been developed as an alternative to hot homogenization. Cold homogenization does not suffer from problems such as temperature-induced drug degradation or drug distribution into the aqueous phase during homogenization. The cold homogenization is particularly useful for solid lipid particles, but can be applied with slight modifications to produce liposomes and lipid micelles. In this technique the drug containing lipid melt is cooled, the solid lipid ground to lipid microparticles and these lipid microparticles are dispersed in a cold surfactant solution yielding a pre-suspension. The pre-suspension is homogenized at or below room temperature, where the gravitation force is strong enough to break the lipid microparticles directly to solid lipid nanoparticles.

2. Ultrasonication/High Speed Homogenization Methods

Lipid particles, including lipid micelles, liposomes, and solid lipid particles, can be prepared by ultrasonication/high speed homogenization. The combination of both ultrasonication and high speed homogenization is particularly useful for the production of smaller lipid particles. Liposomes are formed in the size range from 10 nm to 200 nm, for example, 50 nm to 100 nm, by this process.

3. Solvent Evaporation Methods

Lipid particles can be prepared by solvent evaporation approaches. The lipophilic material is dissolved in a water-immiscible organic solvent (e.g. cyclohexane) that is emulsified in an aqueous phase. Upon evaporation of the solvent, particles dispersion is formed by precipitation of the lipid in the aqueous medium. Parameters such as temperature, pressure, choices of solvents can be used to control particle size and distribution. Solvent evaporation rate can be adjusted through increased/reduced pressure or increased/reduced temperature.

4. Solvent Emulsification-Diffusion Methods

Lipid particles can be prepared by solvent emulsification-diffusion methods. The lipid is first dissolved in an organic phase, such as ethanol and acetone. An acidic aqueous phase is used to adjust the zeta potential to induce lipid coacervation. The continuous flow mode allows the continuous diffusion of water and alcohol, reducing lipid solubility, which causes thermodynamic instability and generates liposomes

5. Supercritical Fluid Methods

Lipid particles, including liposomes and solid lipid particles, can be prepared from supercritical fluid methods. Supercritical fluid approaches have the advantage of replacing or reducing the amount of the organic solvents used in other preparation methods. The lipids, active agents to be encapsulated, and excipients can be solvated at high pressure in a supercritical solvent. The supercritical solvent is most commonly CO₂, although other supercritical solvents are known in the art. To increase solubility of the lipid, a small amount of co-solvent can be used. Ethanol is a common co-solvent, although other small organic solvents that are generally regarded as safe for formulations can be used. The lipid particles, lipid micelles, liposomes, or solid lipid particles can be obtained by expansion of the supercritical solution or by injection into a non-solvent aqueous phase. The particle formation and size distribution can be controlled by adjusting the supercritical solvent, co-solvent, non-solvent, temperatures, pressures, etc.

6. Microemulsion Based Methods

Microemulsion based methods for making lipid particles are known in the art. These methods are based upon the dilution of a multiphase, usually two-phase, system. Emulsion methods for the production of lipid particles generally involve the formation of a water-in-oil emulsion through the addition of a small amount of aqueous media to a larger volume of immiscible organic solution containing the lipid. The mixture is agitated to disperse the aqueous media as tiny droplets throughout the organic solvent and the lipid aligns itself into a monolayer at the boundary between the organic and aqueous phases. The size of the droplets is controlled by pressure, temperature, the agitation applied and the amount of lipid present.

The water-in-oil emulsion can be transformed into a liposomal suspension through the formation of a double emulsion. In a double emulsion, the organic solution containing the water droplets is added to a large volume of aqueous media and agitated, producing a water-in-oil-in-water emulsion. The size and type of lipid particle formed can be controlled by the choice of and amount of lipid, temperature, pressure, co-surfactants, solvents, etc.

7. Spray Drying Methods

Spray drying methods similar to those described above for making polymeric particle can be employed to create solid lipid particles. Typically, this method is used with lipids with a melting point above 70° C.

In some embodiments, conjugates of the present invention may be encapsulated in polymeric particles using a single oil in water emulsion method. As a non-limiting example, the conjugate and a suitable polymer or block copolymer or a mixture of polymers/block copolymers, are dissolved in organic solvents such as, but not limited to, dichloromethane (DCM), ethyl acetate (EtAc) or choloform to form the oil phase. Co-solvents such as, but not limited to, dimethyl formamide (DMF), acetonitrile (CAN) or benzyl alcohol (BA) may be used to control the size of the particles and/or to solubilize the conjugate. Polymers used in the formulation may include, but not limited to, PLA97-b-PEGS, PLA35-b-PEGS and PLA16-b-PEGS copolymers.

In some embodiments, particle formulations may be prepared by varying the lipophilicity of conjugates of the present invention. The lipophilicity may be varied by using hydrophobic ion-pairs or hydrophobic ion-paring (HIP) of the conjugates with different counterions. HIP alters the solubility of the conjugates of the present invention. The aqueous solubility may drop and the solubility in organic phases may increase.

Any suitable agent may be used to provide counterions to form HIP complex with the conjugate of the present invention. In some embodiments, the HIP complex may be formed prior to formulation of the particles.

V. Methods of Using the Conjugates and Particles

The conjugates or particles as described herein can be administered to treat any hyperproliferative disease, metabolic disease, infectious disease, or cancer, as appropriate. The formulations can be used for immunization. Formulations may be administered by injection, orally, or topically, typically to a mucosal surface (lung, nasal, oral, buccal, sublingual, vaginally, rectally) or to the eye (intraocularly or transocularly).

In various embodiments, methods for treating a subject having a cancer are provided, wherein the method comprises administering a therapeutically-effective amount of the conjugates or particles, as described herein, to a subject having a cancer, suspected of having cancer, or having a predisposition to a cancer. According to the present invention, cancer embraces any disease or malady characterized by uncontrolled cell proliferation, e.g., hyperproliferation. Cancers may be characterized by tumors, e.g., solid tumors or any neoplasm.

In some embodiments, the cancer is a solid tumor. Large drug molecules have limited penetration in solid tumors. The penetration of large drug molecules is slow. On the other hand, small molecules such as conjugates of the present invention may penetrate solid tumors rapidly and more deeply. Regarding penetration depth of the drugs, larger molecules penetrate less, despite having more durable pharmacokinectics. Small molecules such as conjugates of the present invention penetrate deeper. Dreher et al. (Dreher et al., JNCI, vol. 98(5):335 (2006), the contents of which are incorporated herein by reference in their entirety) studied penetration of dextrans with different sizes into a tumor xenograft. As summarized in the figure on the top right of page 340 of Dreher (see FIG. 1 of the present application) and Table 1 of Dreher, Dextrans with a molecular weight of 3.3 kDa or 10 kDa showed rapid deep penetration into the tumor tissue (>35 um from the vascular surface of the tumor). However, 40 kDa, 70 kDa or 2 mDa sized dextrans penetrated much less than the 3.3 kDa or 10 kDa dextran. The 70 kDa dextran reached only about 15 um from the vascular surface of the tumor. Conjugates of the present invention have a molecule weight comparable to the 3.3 kDa and 10 kDa dextrans, while antibody drug conjugates have a molecule weight at least as big as the 70 kDa dextran. Therefore, conjugates of the present invention may penetrate deep and rapidly into the core/center of the solid tumor.

In one embodiment, conjugates of the present invention reach at least about 25 μm, about 30 μm, about 35 μm, about 40 μm, about 45 μm, about 50 μm, about 75 μm, about 100 μm, about 150 μm, about 200 μm, about 250 μm, about 300 μm, about 400 μm, about 500 μm, about 600 μm, about 700 μm, about 800 μm, about 900 μm, about 1000 μm, about 1100 μm, about 1200 μm, about 1300 μm, about 1400 μm or about 1500 μm into the solid tumor from the vascular surface of the tumor. Zero distance is defined as the vascular surface of the tumor, and every distance greater than zero is defined as the distance measured in three dimensions to the nearest vascular surface.

In another embodiment, conjugates of the present invention penetrate to the core of the tumor. “Core” of the tumor, as used herein, refers to the central area of the tumor. The distance from any part of the core area of the tumor to the vascular surface of the tumor is between about 30% to about 50% of the length or width of the tumor. The distance from any part of the core area of the tumor to the center point of the tumor is less than about 20% of the length or width of the tumor. The core area of the tumor is roughly the center ⅓ of the tumor.

In another embodiment, conjugates of the present invention conjugates of the present invention penetrate to the middle of the solid tumor. “Middle” of the tumor, as sued herein, refers to the middle area of the tumor. The distance from any part of the middle area of the tumor to the vascular surface of the tumor is between about 15% and about 30% of the length or the width of the tumor. The distance from any part of the middle area of the tumor to the center point of the tumor is between about 20% to about 35% of the length or width of the tumor. The middle area of the tumor is roughly between the center ⅓ of the tumor and the outer ⅓ of the tumor.

In some embodiments, the subject may be otherwise free of indications for treatment with the conjugates or particles. In some embodiments, methods include use of cancer cells, including but not limited to mammalian cancer cells. In some instances, the mammalian cancer cells are human cancer cells.

In some embodiments, the conjugates or particles of the present teachings have been found to inhibit cancer and/or tumor growth. They may also reduce, including cell proliferation, invasiveness, and/or metastasis, thereby rendering them useful for the treatment of a cancer.

In some embodiments, the conjugates or particles of the present teachings may be used to prevent the growth of a tumor or cancer, and/or to prevent the metastasis of a tumor or cancer. In some embodiments, compositions of the present teachings may be used to shrink or destroy a cancer.

In some embodiments, the conjugates or particles provided herein are useful for inhibiting proliferation of a cancer cell. In some embodiments, the conjugates or particles provided herein are useful for inhibiting cellular proliferation, e.g., inhibiting the rate of cellular proliferation, preventing cellular proliferation, and/or inducing cell death. In general, the conjugates or particles as described herein can inhibit cellular proliferation of a cancer cell or both inhibiting proliferation and/or inducing cell death of a cancer cell. In some embodiments, cell proliferation is reduced by at least about 25%, about 50%, about 75%, or about 90% after treatment with conjguates or particles of the present invention compared with cells with no treatment. In some embodiments, cell cycle arrest marker phospho histone H3 (PH3 or PHH3) is increased by at least about 50%, about 75%, about 100%, about 200%, about 400% or about 600% after treatment with conjguates or particles of the present invention compared with cells with no treatment. In some embodiments, cell apoptosis marker cleaved caspase-3 (CC3) is increased by at least 50%, about 75%, about 100%, about 200%, about 400% or about 600% after treatment with conjguates or particles of the present invention compared with cells with no treatment.

Furthermore, in some embodiments, conjugates or particles of the present invention are effective for inhibiting tumor growth, whether measured as a net value of size (weight, surface area or volume) or as a rate over time, in multiple types of tumors.

In some embodiments, the size of a tumor is reduced by about 60% or more after treatment with conjugates or particles of the present invention. In some embodiments, the size of a tumor is reduced by at least about 20%, at least about 30%, at least about 40%, at least about 50%, at least about 60%, at least about 70%, at least about 80%, at least about 90%, at least about 95%, at least about 96%, at least about 97%, at least about 98%, at least about 99%, at least about 100%, by a measure of weight, and/or area and/or volume.

The cancers treatable by methods of the present teachings generally occur in mammals. Mammals include, for example, humans, non-human primates, dogs, cats, rats, mice, rabbits, ferrets, guinea pigs, horses, pigs, sheep, goats, and cattle. In various embodiments, the cancer is lung cancer, breast cancer, e.g., mutant BRCA1 and/or mutant BRCA2 breast cancer, non-BRCA-associated breast cancer, colorectal cancer, ovarian cancer, pancreatic cancer, colorectal cancer, bladder cancer, prostate cancer, cervical cancer, renal cancer, leukemia, central nervous system cancers, myeloma, and melanoma.

In some embodiments, the cancer is a neuroendocrine cancer such as but not limited to small cell lung cancer (SCLC), adrenal medullary tumors (e.g., pheochromocytoma, neuroblastoma, ganglioneuroma, or paraganglioma), gastroenteropancreatic neuroendocrine tumors (e.g., carcinoids, gastrinoma, glucagonoma, vasoactive intestinal polypeptide-secreting tumor, pancreatic polypeptide-secreting tumor, or nonfunctioning gastroenteropancreatic tumors), meduallary thyroid cancer, Merkel cell tumor of the skin, pituitary adenoma, and pancreatic cancer. The somatostain receptor SSTR2 is over expressed on 50-90% of neuroendocrine cancers. In some embodiments, the neuroendocrine cancer is a primary neuroendocrine cancer. In some embodiments, the neuroendocrine cancer is a neuroendocrine metastatsis. Neuroendocrine metastatis may be in liver, lung, bone, or brain of a subject. In certain embodiments, the cancer is brain cancer, human lung carcinoma, ovarian cancer, pancreatic cancer or colorectal cancer.

In one embodiment, the conjugates or particles as described herein or formulations containing the conjugates or particles as described herein are used to treat small cell lung cancer. About 12%-15% of patients having lung cancer have small cell lung cancer. Survival in metastatic small cell lung caner is poor. Survival rate is below 5% five years after diagnosis. US incidence of small cell lung cancer is about 26K-30K. Among these patients, about 40%-80% are SSTR2 positive.

In some embodiments, the conjugates or particles as described herein or formulations containing the conjugates or particles as described herein are used to treat paitents with tumors that express or over-express the somatostatn receptor. Such patients can be identified with any method known in the art, such as but not limted to using a radionuclide imaging agent, a radiolabeled somatostatin analog imaging agent, SSTR scintigraphy or SSTR positron emission tomography (PET). In one embodiment, ¹¹¹Indium (Indium111)-labeled pentetreotide scintigraphy (OctreoScan™) is used to identify patients with SSTR-expressing tumors. In another embodiment, a 68Ga conjugate such as 68Ga-DOTA-TATE, 68Ga-DOTA-TOC, or 68Ga-DOTA-NOC is used in PET imaging to identify patients with SSTR-expressing tumors. Patients who show positive scan results detected with Indium111-labeled pentetreotide scintigraphy are treated with conjguates or particles of the present invention.

In one embodiment, the conjugates or particles as described herein or formulations containing the conjugates or particles as described herein are used to treat pateints having a histologically proven locally advanced or metastatic high grade neuroendocrine carcinoma (NEC). In some embodiments, the patients may have small cell and large cell neuroendocrine carcinoma of unknown primary or any extrapulmonary site. In some embodiments, the pateints may have well differentiated G3 neuroendocrine neoplasms if Ki-67>30%. In some embodiments, the pateints may have neuroendocrine prostate cancer (de novo or treatment-emergent) of prostate if small cell or large cell histology. In some embodiments, the patients may have mixed tumors, e.g. mixed adenoneuroendocrine carcinoma (MANEC) or mixed squamous or acinar cell NEC if the high grade (small or large cell) NEC component comprises >50% of the original sample or subsequent biopsy. In some embodiments, the patients may have castrate resistant prostate cancer (CRPC). In some embodiments, patients may be selected or stratified by having, or not having, any of the foregoing conditions.

In some embodiments, Conjugate 57 or its pharmaceutically acceptable salt is administered to patients diagnosed with pancreatic cancer, gastrointestinal (GI) cancer (such as small intestine cancer, stomach cancer, rectum cancer, ileum cancer, colon cancer, small bowel cancer, large bowel cancer, gastric cancer, etc.), lung cancer (such as large-cell neuroendocrine carcinoma (LCNEC) of the lung, small cell lung cancer (SCLC), etc.), or pheochromocytoma. In some embodiments, patients treated may have, or not have, been diagnosed with any of the foregoing conditions prior to such treatment.

In some embodiments, the patients have a metastatic cancer. In some embodiments, the patients have metastasis to lymph nodes, liver, lung, peritoneum, back, bone, soft tissues outside of uterus, kidney, or vertebral column. In some embodiments, patients treated may have, or not have, been diagnosed with any of the foregoing conditions prior to such treatment.

In some embodiments, the patients have had prior cancer treatment therapies. In some embodiments, the patients have previously been treated with lancreotide, mTOR kinase inhibitor, Lutathera (a lutetium-177 (Lu-177) labeled somatostatin analogue peptide), sunitinib, cyclophosphamide, vincristine, dacarbazine, octreotide, carbo, streptozocin, a FOLFIRI therapy (a combination therapy comprising folinic acid (e.g., leucovorin), fluorouracil (5-FU), and irinotecan (e.g., Camptosar))

In some embodiments, the patients are male. In some embodiments, the patients are female. In some embodiments, the patients are at least 18 years old. In some embodiments, the patients are at least 40 years old. In some embodiments, the pateints are at least 60 years old.

A feature of conjugates or particles of the present invention is relatively low toxicity to an organism while maintaining efficacy at inhibiting, e.g. slowing or stopping tumor growth. As used herein, “toxicity” refers to the capacity of a substance or composition to be harmful or poisonous to a cell, tissue organism or cellular environment. Low toxicity refers to a reduced capacity of a substance or composition to be harmful or poisonous to a cell, tissue organism or cellular environment. Such reduced or low toxicity may be relative to a standard measure, relative to a treatment or relative to the absence of a treatment. For example, conjugates or particles of the present invention may have lower toxicity than the active agent moiety Z administered alone. For conjugates comprsing DM1, their toxicity is lower than DM1 administered alone.

Toxicity may further be measured relative to a subject's weight loss where weight loss over 15%, over 20% or over 30% of the body weight is indicative of toxicity. Other metrics of toxicity may also be measured such as patient presentation metrics including lethargy and general malaiase. Neutropenia, thrombopenia, white blood cell (WBC) count, complete blood cell (CBC) count may also be metrics of toxicity. Pharmacologic indicators of toxicity include elevated aminotransferases (AST/ALT) levels, neurotoxicity, kidney damage, GI damage and the like. In one embodiment, conjugates or particles of the present invention do not cause a significant change of a subject's body weight. The body weight loss of a subject is less about 30%, about 20%, about 15%, about 10%, or about 5% after treatment with conjguates or particles of the present invention. In another embodiment, conjugates or particles of the present invention do not cause a significant increase of a subject's AST/ALT levels. The AST or ALT level of a subject is increased by less than about 30%, about 20%, about 15%, about 10%, or about 5% after treatment with conjugates or particles of the present invention. In yet another embodiment, conjugates or particles of the present invention do not cause a significant change of a subject's CBC or WBC count after treatment with conjugates or particles of the present invention. The CBC or WBC level of a subject is decreased by less than about 30%, about 20%, about 15%, about 10%, or about 5% after treatment with conjugates or particles of the present invention.

In some embodiments, Conjugate 57 is administered to a patient and any one or more of white blood cells (WBC), red blood cells (RBC), hemoglobin, platelets, neutrophils, lymphocytes, blood urea nitrogen (BUN), creatinine, glucose, albumin, total protein, calcium levels, magnesium levels, alkaline phosphatase, total bilirubin, direct bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), amylase, lipase, international normalized ratio (INR), the prothrombin time (PT), and/or activated partial thromboplastin time (aPTT) of the patient are measured.

In some embodiments, the treatment-related adverse effects (AE) of a pharmaceutical composition comprising Conjugate 57 may include nausea, fatigue, increased alanine aminotransferase, constipation, diarrhea, increased aspartate aminotransferase, pyrexia, abdominal distension, abdominal pain, anaemia, arthralgia, increased blood alkaline phosphatase, increased blood creatinine, decreased appetite, dyspepsia, hypertension, hypoalbuminaemia, hypotension, insomnia, increased lipase, pain in extremity, paraesthesia, pelvic pain, and/or urinary tract infection.

In some embodiments, less than 30% of the patient population has any one or more treatment-related adverse effects. In some embodiments, a single patient experiences treatment-related adverse effects in less 30% of the whole treatment time.

In some embodiments, the patients treated with Conjguate 57 have lower, reduced or no circulating tumor cells.

In some embodiments, Conjugate 57 has a half life of about 1.8 hours in a patient.

In some embodiments, conjugates or particles of the present invention are combined with at least one additional active agent. The active agent may be any suitable drug. It may be selected from any active agent described herein such as a drug for treating cancer. It may also be a cancer symptom relief drug. Non-limiting examples of symptom relief drugs include: octreotide or lanreotide; interferon, cypoheptadine or any other antihistamines. In some embodiments, conjugates or particles of the present invention do not have drug-drug interference with the additional active agent. In one embodiment, conjugates or particles of the present invention do not inhibit cytochrome P450 (CYP) isozymes. CYP isozymes may include CYP3A4 Midazolam, CYP3A4 Testosterone, CYP2C9, CYP2D6, CYP1A2, CYP2C8, CYP2B6, and CYP2C19. The additional active agent may be administered concomitantly with conjguates or particles of the present invention.

In some embodiments, the additional active agent may not bind to any somatostatin receptor. In one embodiment, the additional active agent is a cancer symptom relief drug. The symptom relief drug may reduce diarrhea or the side effects of chemotherapy or radiation therapy. In one example, conjugates or particles of the present invention may be combined with a symptom relief drug for carcinoid symdrome, such as telotristat or telotristat etiprate (LX1032, Lexicon®). Telotristat etiprate is telotristat's crystalline hippurate salt as disclosed in WO2013059146 to Chen et al., the contents of which are incorporated herein by reference in their entirety. Telotristat, its salts and crystalline forms can be obtained by methods known in the art (see U.S. Pat. No. 7,709,493 to Devasagayaraj et al., the contents of which are incorporated herein by reference in their entirety). Any other compound disclosed in U.S. Pat. No. 7,709,493 may be combined with conjugates or particles of the present invention.

Telotristat:

In another example, conjugates or particles of the present invention may be combined with a moderate dose of chemotherapy agents such as mitomycin C, vinblastine and cisplatin (see Ellis et al., Br J Cancer, vol. 71(2): 366-370 (1995), the contents of which are incorporated herein by reference in their entirety).

The conjugates or particles as described herein or formulations containing the conjugates or particles as described herein can be used for the selective tissue delivery of a therapeutic, prophylactic, or diagnostic agent to an individual or patient in need thereof. For example, DM1 conjugates or particles of the present invention are used to deliver DM1 to selective tissues. These tissues may be tumor tissues. Dosage regimens may be adjusted to provide the optimum desired response (e.g., a therapeutic or prophylactic response). For example, a single bolus may be administered, several divided doses may be administered over time or the dose may be proportionally reduced or increased as indicated by the exigencies of the therapeutic situation. Dosage unit form as used herein refers to physically discrete units suited as unitary dosages for the mammalian subjects to be treated; each unit containing a predetermined quantity of active compound calculated to produce the desired therapeutic.

In various embodiments, a conjugate contained within a particle is released in a controlled manner. The release can be in vitro or in vivo. For example, particles can be subject to a release test under certain conditions, including those specified in the U.S. Pharmacopeia and variations thereof.

In various embodiments, less than about 90%, less than about 80%, less than about 70%, less than about 60%, less than about 50%, less than about 40%, less than about 30%, less than about 20% of the conjugate contained within particles is released in the first hour after the particles are exposed to the conditions of a release test. In some embodiments, less that about 90%, less than about 80%, less than about 70%, less than about 60%, or less than about 50% of the conjugate contained within particles is released in the first hour after the particles are exposed to the conditions of a release test. In certain embodiments, less than about 50% of the conjugate contained within particles is released in the first hour after the particles are exposed to the conditions of a release test.

With respect to a conjugate being released in vivo, for instance, the conjugate contained within a particle administered to a subject may be protected from a subject's body, and the body may also be isolated from the conjugate until the conjugate is released from the particle.

Thus, in some embodiments, the conjugate may be substantially contained within the particle until the particle is delivered into the body of a subject. For example, less than about 90%, less than about 80%, less than about 70%, less than about 60%, less than about 50%, less than about 40%, less than about 30%, less than about 20%, less than about 15%, less than about 10%, less than about 5%, or less than about 1% of the total conjugate is released from the particle prior to the particle being delivered into the body, for example, a treatment site, of a subject. In some embodiments, the conjugate may be released over an extended period of time or by bursts (e.g., amounts of the conjugate are released in a short period of time, followed by a period of time where substantially no conjugate is released). For example, the conjugate can be released over 6 hours, 12 hours, 24 hours, or 48 hours. In certain embodiments, the conjugate is released over one week or one month.

VI. Kits and Devices

The invention provides a variety of kits and devices for conveniently and/or effectively carrying out methods of the present invention. Typically kits will comprise sufficient amounts and/or numbers of components to allow a user to perform multiple treatments of a subject(s) and/or to perform multiple experiments.

In one embodiment, the present invention provides kits for inhibiting tumor cell growth in vitro or in vivo, comprising a conjugate and/or particle of the present invention or a combination of conjugates and/or particles of the present invention, optionally in combination with any other active agents.

The kit may further comprise packaging and instructions and/or a delivery agent to form a formulation composition. The delivery agent may comprise a saline, a buffered solution, or any delivery agent disclosed herein. The amount of each component may be varied to enable consistent, reproducible higher concentration saline or simple buffer formulations. The components may also be varied in order to increase the stability of the conjugates and/or particles in the buffer solution over a period of time and/or under a variety of conditions.

The present invention provides for devices which may incorporate conjugates and/or particles of the present invention. These devices contain in a stable formulation available to be immediately delivered to a subject in need thereof, such as a human patient. In some embodiments, the subject has cancer.

Non-limiting examples of the devices include a pump, a catheter, a needle, a transdermal patch, a pressurized olfactory delivery device, iontophoresis devices, multi-layered microfluidic devices. The devices may be employed to deliver conjugates and/or particles of the present invention according to single, multi- or split-dosing regiments. The devices may be employed to deliver conjugates and/or particles of the present invention across biological tissue, intradermal, subcutaneously, or intramuscularly.

VII. Definitions

The term “compound”, as used herein, is meant to include all stereoisomers, geometric isomers, tautomers, and isotopes of the structures depicted. In the present application, compound is used interechangably with conjugate. Therefore, conjugate, as used herein, is also meant to include all stereoisomers, geometric isomers, tautomers, and isotopes of the structures depicted.

The compounds described herein can be asymmetric (e.g., having one or more stereocenters). All stereoisomers, such as enantiomers and diastereomers, are intended unless otherwise indicated. Compounds of the present disclosure that contain asymmetrically substituted carbon atoms can be isolated in optically active or racemic forms. Methods on how to prepare optically active forms from optically active starting materials are known in the art, such as by resolution of racemic mixtures or by stereoselective synthesis. Many geometric isomers of olefins, C═N double bonds, and the like can also be present in the compounds described herein, and all such stable isomers are contemplated in the present disclosure. Cis and trans geometric isomers of the compounds of the present disclosure are described and may be isolated as a mixture of isomers or as separated isomeric forms.

Compounds of the present disclosure also include tautomeric forms. Tautomeric forms result from the swapping of a single bond with an adjacent double bond and the concomitant migration of a proton. Tautomeric forms include prototropic tautomers which are isomeric protonation states having the same empirical formula and total charge. Examples prototropic tautomers include ketone—enol pairs, amide—imidic acid pairs, lactam—lactim pairs, amide—imidic acid pairs, enamine—imine pairs, and annular forms where a proton can occupy two or more positions of a heterocyclic system, such as, 1H- and 3H-imidazole, 1H-, 2H- and 4H-1,2,4-triazole, 1H- and 2H-isoindole, and 1H- and 2H-pyrazole. Tautomeric forms can be in equilibrium or sterically locked into one form by appropriate substitution.

Compounds of the present disclosure also include all of the isotopes of the atoms occurring in the intermediate or final compounds. “Isotopes” refers to atoms having the same atomic number but different mass numbers resulting from a different number of neutrons in the nuclei. For example, isotopes of hydrogen include tritium and deuterium.

The compounds and salts of the present disclosure can be prepared in combination with solvent or water molecules to form solvates and hydrates by routine methods.

The terms “subject” or “patient”, as used herein, refer to any organism to which the particles may be administered, e.g., for experimental, therapeutic, diagnostic, and/or prophylactic purposes. Typical subjects include animals (e.g., mammals such as mice, rats, rabbits, guinea pigs, cattle, pigs, sheep, horses, dogs, cats, hamsters, lamas, non-human primates, and humans).

The terms “treating” or “preventing”, as used herein, can include preventing a disease, disorder or condition from occurring in an animal that may be predisposed to the disease, disorder and/or condition but has not yet been diagnosed as having the disease, disorder or condition; inhibiting the disease, disorder or condition, e.g., impeding its progress; and relieving the disease, disorder, or condition, e.g., causing regression of the disease, disorder and/or condition. Treating the disease, disorder, or condition can include ameliorating at least one symptom of the particular disease, disorder, or condition, even if the underlying pathophysiology is not affected, such as treating the pain of a subject by administration of an analgesic agent even though such agent does not treat the cause of the pain.

A “target”, as used herein, shall mean a site to which targeted constructs bind. A target may be either in vivo or in vitro. In certain embodiments, a target may be cancer cells found in leukemias or tumors (e.g., tumors of the brain, lung (small cell and non-small cell), ovary, prostate, breast and colon as well as other carcinomas and sarcomas). In still other embodiments, a target may refer to a molecular structure to which a targeting moiety or ligand binds, such as a hapten, epitope, receptor, dsDNA fragment, carbohydrate or enzyme. A target may be a type of tissue, e.g., neuronal tissue, intestinal tissue, pancreatic tissue, liver, kidney, prostate, ovary, lung, bone marrow, or breast tissue.

The “target cells” that may serve as the target for the method or conjugates or particles, are generally animal cells, e.g., mammalian cells. The present method may be used to modify cellular function of living cells in vitro, i.e., in cell culture, or in vivo, in which the cells form part of or otherwise exist in animal tissue. Thus, the target cells may include, for example, the blood, lymph tissue, cells lining the alimentary canal, such as the oral and pharyngeal mucosa, cells forming the villi of the small intestine, cells lining the large intestine, cells lining the respiratory system (nasal passages/lungs) of an animal (which may be contacted by inhalation of the subject invention), dermal/epidermal cells, cells of the vagina and rectum, cells of internal organs including cells of the placenta and the so-called blood/brain barrier, etc. In general, a target cell expresses at least one type of SSTR. In some embodiments, a target cell can be a cell that expresses an SSTR and is targeted by a conjugate described herein, and is near a cell that is affected by release of the active agent of the conjugate. For example, a blood vessel expressing an SSTR that is in proximity to a tumor may be the target, while the active agent released at the site will affect the tumor.

The term “therapeutic effect” is art-recognized and refers to a local or systemic effect in animals, particularly mammals, and more particularly humans caused by a pharmacologically active substance. The term thus means any substance intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease, disorder or condition in the enhancement of desirable physical or mental development and conditions in an animal, e.g., a human.

The term “modulation” is art-recognized and refers to up regulation (i.e., activation or stimulation), down regulation (i.e., inhibition or suppression) of a response, or the two in combination or apart. The modulation is generally compared to a baseline or reference that can be internal or external to the treated entity.

“Parenteral administration”, as used herein, means administration by any method other than through the digestive tract (enteral) or non-invasive topical routes. For example, parenteral administration may include administration to a patient intravenously, intradermally, intraperitoneally, intrapleurally, intratracheally, intraossiously, intracerebrally, intrathecally, intramuscularly, subcutaneously, subjunctivally, by injection, and by infusion.

“Topical administration”, as used herein, means the non-invasive administration to the skin, orifices, or mucosa. Topical administration can be delivered locally, i.e., the therapeutic can provide a local effect in the region of delivery without systemic exposure or with minimal systemic exposure. Some topical formulations can provide a systemic effect, e.g., via adsorption into the blood stream of the individual. Topical administration can include, but is not limited to, cutaneous and transdermal administration, buccal administration, intranasal administration, intravaginal administration, intravesical administration, ophthalmic administration, and rectal administration.

“Enteral administration”, as used herein, means administration via absorption through the gastrointestinal tract. Enteral administration can include oral and sublingual administration, gastric administration, or rectal administration.

“Pulmonary administration”, as used herein, means administration into the lungs by inhalation or endotracheal administration. As used herein, the term “inhalation” refers to intake of air to the alveoli. The intake of air can occur through the mouth or nose.

The terms “sufficient” and “effective”, as used interchangeably herein, refer to an amount (e.g., mass, volume, dosage, concentration, and/or time period) needed to achieve one or more desired result(s). A “therapeutically effective amount” is at least the minimum concentration required to effect a measurable improvement or prevention of at least one symptom or a particular condition or disorder, to effect a measurable enhancement of life expectancy, or to generally improve patient quality of life. The therapeutically effective amount is thus dependent upon the specific biologically active molecule and the specific condition or disorder to be treated. Therapeutically effective amounts of many active agents, such as antibodies, are known in the art. The therapeutically effective amounts of compounds and compositions described herein, e.g., for treating specific disorders may be determined by techniques that are well within the craft of a skilled artisan, such as a physician.

The terms “bioactive agent” and “active agent”, as used interchangeably herein, include, without limitation, physiologically or pharmacologically active substances that act locally or systemically in the body. A bioactive agent is a substance used for the treatment (e.g., therapeutic agent), prevention (e.g., prophylactic agent), diagnosis (e.g., diagnostic agent), cure or mitigation of disease or illness, a substance which affects the structure or function of the body, or pro-drugs, which become biologically active or more active after they have been placed in a predetermined physiological environment.

The term “prodrug” refers to an agent, including a small organic molecule, peptide, nucleic acid or protein, that is converted into a biologically active form in vitro and/or in vivo. Prodrugs can be useful because, in some situations, they may be easier to administer than the parent compound (the active compound). For example, a prodrug may be bioavailable by oral administration whereas the parent compound is not. The prodrug may also have improved solubility in pharmaceutical compositions compared to the parent drug. A prodrug may also be less toxic than the parent. A prodrug may be converted into the parent drug by various mechanisms, including enzymatic processes and metabolic hydrolysis. Harper, N.J. (1962) Drug Latentiation in Jucker, ed. Progress in Drug Research, 4:221-294; Morozowich et al. (1977) Application of Physical Organic Principles to Prodrug Design in E. B. Roche ed. Design of Biopharmaceutical Properties through Prodrugs and Analogs, APhA; Acad. Pharm. Sci.; E. B. Roche, ed. (1977) Bioreversible Carriers in Drug in Drug Design, Theory and Application, APhA; H. Bundgaard, ed. (1985) Design of Prodrugs, Elsevier; Wang et al. (1999) Prodrug approaches to the improved delivery of peptide drug, Curr. Pharm. Design. 5(4):265-287; Pauletti et al. (1997) Improvement in peptide bioavailability: Peptidomimetics and Prodrug Strategies, Adv. Drug. Delivery Rev. 27:235-256; Mizen et al. (1998). The Use of Esters as Prodrugs for Oral Delivery of β-Lactam antibiotics, Pharm. Biotech. 11:345-365; Gaignault et al. (1996) Designing Prodrugs and Bioprecursors I. Carrier Prodrugs, Pract. Med. Chem. 671-696; M. Asgharnejad (2000). Improving Oral Drug Transport Via Prodrugs, in G. L. Amidon, P. I. Lee and E. M. Topp, Eds., Transport Processes in Pharmaceutical Systems, Marcell Dekker, p. 185-218; Balant et al. (1990) Prodrugs for the improvement of drug absorption via different routes of administration, Eur. J. Drug Metab. Pharmacokinet., 15(2): 143-53; Balimane and Sinko (1999). Involvement of multiple transporters in the oral absorption of nucleoside analogues, Adv. Drug Delivery Rev., 39(1-3):183-209; Browne (1997). Fosphenytoin (Cerebyx), Clin. Neuropharmacol. 20(1): 1-12; Bundgaard (1979). Bioreversible derivatization of drugs—principle and applicability to improve the therapeutic effects of drugs, Arch. Pharm. Chemi. 86(1): 1-39; H. Bundgaard, ed. (1985) Design of Prodrugs, New York: Elsevier; Fleisher et al. (1996) Improved oral drug delivery: solubility limitations overcome by the use of prodrugs, Adv. Drug Delivery Rev. 19(2): 115-130; Fleisher et al. (1985) Design of prodrugs for improved gastrointestinal absorption by intestinal enzyme targeting, Methods Enzymol. 112: 360-81; Farquhar D, et al. (1983) Biologically Reversible Phosphate-Protective Groups, J. Pharm. Sci., 72(3): 324-325; Han, H. K. et al. (2000) Targeted prodrug design to optimize drug delivery, AAPS PharmSci., 2(1): E6; Sadzuka Y. (2000) Effective prodrug liposome and conversion to active metabolite, Curr. Drug Metab., 1(1):31-48; D. M. Lambert (2000) Rationale and applications of lipids as prodrug carriers, Eur. J. Pharm. Sci., 11 Suppl. 2:S15-27; Wang, W. et al. (1999) Prodrug approaches to the improved delivery of peptide drugs. Curr. Pharm. Des., 5(4):265-87.

The term “biocompatible”, as used herein, refers to a material that along with any metabolites or degradation products thereof that are generally non-toxic to the recipient and do not cause any significant adverse effects to the recipient. Generally speaking, biocompatible materials are materials which do not elicit a significant inflammatory or immune response when administered to a patient.

The term “biodegradable” as used herein, generally refers to a material that will degrade or erode under physiologic conditions to smaller units or chemical species that are capable of being metabolized, eliminated, or excreted by the subject. The degradation time is a function of composition and morphology. Degradation times can be from hours to weeks.

The term “pharmaceutically acceptable”, as used herein, refers to compounds, materials, compositions, and/or dosage forms that are, within the scope of sound medical judgment, suitable for use in contact with the tissues of human beings and animals without excessive toxicity, irritation, allergic response, or other problems or complications commensurate with a reasonable benefit/risk ratio, in accordance with the guidelines of agencies such as the U.S. Food and Drug Administration. A “pharmaceutically acceptable carrier”, as used herein, refers to all components of a pharmaceutical formulation that facilitate the delivery of the composition in vivo. Pharmaceutically acceptable carriers include, but are not limited to, diluents, preservatives, binders, lubricants, disintegrators, swelling agents, fillers, stabilizers, and combinations thereof.

The term “molecular weight”, as used herein, generally refers to the mass or average mass of a material. If a polymer or oligomer, the molecular weight can refer to the relative average chain length or relative chain mass of the bulk polymer. In practice, the molecular weight of polymers and oligomers can be estimated or characterized in various ways including gel permeation chromatography (GPC) or capillary viscometry. GPC molecular weights are reported as the weight-average molecular weight (Mw) as opposed to the number-average molecular weight (Mn). Capillary viscometry provides estimates of molecular weight as the inherent viscosity determined from a dilute polymer solution using a particular set of concentration, temperature, and solvent conditions.

The term “small molecule”, as used herein, generally refers to an organic molecule that is less than 2000 g/mol in molecular weight, less than 1500 g/mol, less than 1000 g/mol, less than 800 g/mol, or less than 500 g/mol. Small molecules are non-polymeric and/or non-oligomeric.

The term “hydrophilic”, as used herein, refers to substances that have strongly polar groups that readily interact with water.

The term “hydrophobic”, as used herein, refers to substances that lack an affinity for water; tending to repel and not absorb water as well as not dissolve in or mix with water.

The term “lipophilic”, as used herein, refers to compounds having an affinity for lipids.

The term “amphiphilic”, as used herein, refers to a molecule combining hydrophilic and lipophilic (hydrophobic) properties. “Amphiphilic material” as used herein refers to a material containing a hydrophobic or more hydrophobic oligomer or polymer (e.g., biodegradable oligomer or polymer) and a hydrophilic or more hydrophilic oligomer or polymer.

The term “targeting moiety”, as used herein, refers to a moiety that binds to or localizes to a specific locale. The moiety may be, for example, a protein, nucleic acid, nucleic acid analog, carbohydrate, or small molecule. The locale may be a tissue, a particular cell type, or a subcellular compartment. In some embodiments, a targeting moiety can specifically bind to a selected molecule.

The term “reactive coupling group”, as used herein, refers to any chemical functional group capable of reacting with a second functional group to form a covalent bond. The selection of reactive coupling groups is within the ability of those in the art. Examples of reactive coupling groups can include primary amines (—NH₂) and amine-reactive linking groups such as isothiocyanates, isocyanates, acyl azides, NHS esters, sulfonyl chlorides, aldehydes, glyoxals, epoxides, oxiranes, carbonates, aryl halides, imidoesters, carbodiimides, anhydrides, and fluorophenyl esters. Most of these conjugate to amines by either acylation or alkylation. Examples of reactive coupling groups can include aldehydes (—COH) and aldehyde reactive linking groups such as hydrazides, alkoxyamines, and primary amines. Examples of reactive coupling groups can include thiol groups (—SH) and sulfhydryl reactive groups such as maleimides, haloacetyls, and pyridyl disulfides. Examples of reactive coupling groups can include photoreactive coupling groups such as aryl azides or diazirines. The coupling reaction may include the use of a catalyst, heat, pH buffers, light, or a combination thereof.

The term “protective group”, as used herein, refers to a functional group that can be added to and/or substituted for another desired functional group to protect the desired functional group from certain reaction conditions and selectively removed and/or replaced to deprotect or expose the desired functional group. Protective groups are known to the skilled artisan. Suitable protective groups may include those described in Greene and Wuts, Protective Groups in Organic Synthesis, (1991). Acid sensitive protective groups include dimethoxytrityl (DMT), tert-butylcarbamate (tBoc) and trifluoroacetyl (tFA). Base sensitive protective groups include 9-fluorenylmethoxycarbonyl (Fmoc), isobutyrl (iBu), benzoyl (Bz) and phenoxyacetyl (pac). Other protective groups include acetamidomethyl, acetyl, tert-amyloxycarbonyl, benzyl, benzyloxycarbonyl, 2-(4-biphcnylyl)-2-propy!oxycarbonyl, 2-bromobenzyloxycarbonyl, tert-butyl₇ tert-butyloxycarbonyl, 1-carbobenzoxamido-2,2.2-trifluoroethyl, 2,6-dichlorobenzyl, 2-(3,5-dimethoxyphenyl)-2-propyloxycarbonyl, 2,4-dinitrophenyl, dithiasuccinyl, formyl, 4-methoxybenzenesulfonyl, 4-methoxybenzyl, 4-methylbenzyl, o-nitrophenylsulfenyl, 2-phenyl-2-propyloxycarbonyl, α-2,4,5-tetramethylbenzyloxycarbonyl, p-toluenesulfonyl, xanthenyl, benzyl ester, N-hydroxysuccinimide ester, p-nitrobenzyl ester, p-nitrophenyl ester, phenyl ester, p-nitrocarbonate, p-nitrobenzylcarbonate, trimethylsilyl and pentachlorophenyl ester.

The term “activated ester”, as used herein, refers to alkyl esters of carboxylic acids where the alkyl is a good leaving group rendering the carbonyl susceptible to nucleophilic attack by molecules bearing amino groups. Activated esters are therefore susceptible to aminolysis and react with amines to form amides. Activated esters contain a carboxylic acid ester group —CO₂R where R is the leaving group.

The term “alkyl” refers to the radical of saturated aliphatic groups, including straight-chain alkyl groups, branched-chain alkyl groups, cycloalkyl (alicyclic) groups, alkyl-substituted cycloalkyl groups, and cycloalkyl-substituted alkyl groups.

In some embodiments, a straight chain or branched chain alkyl has 30 or fewer carbon atoms in its backbone (e.g., C₁-C₃₀ for straight chains, C₃-C₃₀ for branched chains), 20 or fewer, 12 or fewer, or 7 or fewer. Likewise, in some embodiments cycloalkyls have from 3-10 carbon atoms in their ring structure, e.g., have 5, 6 or 7 carbons in the ring structure. The term “alkyl” (or “lower alkyl”) as used throughout the specification, examples, and claims is intended to include both “unsubstituted alkyls” and “substituted alkyls”, the latter of which refers to alkyl moieties having one or more substituents replacing a hydrogen on one or more carbons of the hydrocarbon backbone. Such substituents include, but are not limited to, halogen, hydroxyl, carbonyl (such as a carboxyl, alkoxycarbonyl, formyl, or an acyl), thiocarbonyl (such as a thioester, a thioacetate, or a thioformate), alkoxyl, phosphoryl, phosphate, phosphonate, a hosphinate, amino, amido, amidine, imine, cyano, nitro, azido, sulfhydryl, alkylthio, sulfate, sulfonate, sulfamoyl, sulfonamido, sulfonyl, heterocyclyl, aralkyl, or an aromatic or heteroaromatic moiety.

Unless the number of carbons is otherwise specified, “lower alkyl” as used herein means an alkyl group, as defined above, but having from one to ten carbons, or from one to six carbon atoms in its backbone structure. Likewise, “lower alkenyl” and “lower alkynyl” have similar chain lengths. In some embodiments, alkyl groups are lower alkyls. In some embodiments, a substituent designated herein as alkyl is a lower alkyl.

It will be understood by those skilled in the art that the moieties substituted on the hydrocarbon chain can themselves be substituted, if appropriate. For instance, the substituents of a substituted alkyl may include halogen, hydroxy, nitro, thiols, amino, azido, imino, amido, phosphoryl (including phosphonate and phosphinate), sulfonyl (including sulfate, sulfonamido, sulfamoyl and sulfonate), and silyl groups, as well as ethers, alkylthios, carbonyls (including ketones, aldehydes, carboxylates, and esters), —CF₃, —CN and the like. Cycloalkyls can be substituted in the same manner.

The term “heteroalkyl”, as used herein, refers to straight or branched chain, or cyclic carbon-containing radicals, or combinations thereof, containing at least one heteroatom. Suitable heteroatoms include, but are not limited to, O, N, Si, P, Se, B, and S, wherein the phosphorous and sulfur atoms are optionally oxidized, and the nitrogen heteroatom is optionally quaternized. Heteroalkyls can be substituted as defined above for alkyl groups.

The term “alkylthio” refers to an alkyl group, as defined above, having a sulfur radical attached thereto. In some embodiments, the “alkylthio” moiety is represented by one of —S-alkyl, —S-alkenyl, and —S-alkynyl. Representative alkylthio groups include methylthio, and ethylthio. The term “alkylthio” also encompasses cycloalkyl groups, alkene and cycloalkene groups, and alkyne groups. “Arylthio” refers to aryl or heteroaryl groups. Alkylthio groups can be substituted as defined above for alkyl groups.

The terms “alkenyl” and “alkynyl”, refer to unsaturated aliphatic groups analogous in length and possible substitution to the alkyls described above, but that contain at least one double or triple bond respectively.

The terms “alkoxyl” or “alkoxy” as used herein refers to an alkyl group, as defined above, having an oxygen radical attached thereto. Representative alkoxyl groups include methoxy, ethoxy, propyloxy, and tert-butoxy. An “ether” is two hydrocarbons covalently linked by an oxygen. Accordingly, the substituent of an alkyl that renders that alkyl an ether is or resembles an alkoxyl, such as can be represented by one of —O-alkyl, —O-alkenyl, and —O-alkynyl. Aroxy can be represented by —O-aryl or O-heteroaryl, wherein aryl and heteroaryl are as defined below. The alkoxy and aroxy groups can be substituted as described above for alkyl.

The terms “amine” and “amino” are art-recognized and refer to both unsubstituted and substituted amines, e.g., a moiety that can be represented by the general formula:

wherein R₉, R₁₀, and R′₁₀ each independently represent a hydrogen, an alkyl, an alkenyl, —(CH₂)_(m)—R₈ or R₉ and R₁₀ taken together with the N atom to which they are attached complete a heterocycle having from 4 to 8 atoms in the ring structure; R₈ represents an aryl, a cycloalkyl, a cycloalkenyl, a heterocycle or a polycycle; and m is zero or an integer in the range of 1 to 8. In some embodiments, only one of R₉ or R₁₀ can be a carbonyl, e.g., R₉, R₁₀ and the nitrogen together do not form an imide. In still other embodiments, the term “amine” does not encompass amides, e.g., wherein one of R₉ and R₁₀ represents a carbonyl. In additional embodiments, R₉ and R₁₀ (and optionally R′₁₀) each independently represent a hydrogen, an alkyl or cycloalkly, an alkenyl or cycloalkenyl, or alkynyl. Thus, the term “alkylamine” as used herein means an amine group, as defined above, having a substituted (as described above for alkyl) or unsubstituted alkyl attached thereto, i.e., at least one of R₉ and R₁₀ is an alkyl group.

The term “amido” is art-recognized as an amino-substituted carbonyl and includes a moiety that can be represented by the general formula:

wherein R₉ and R₁₀ are as defined above.

“Aryl”, as used herein, refers to C₅-C₁₀-membered aromatic, heterocyclic, fused aromatic, fused heterocyclic, biaromatic, or bihetereocyclic ring systems. Broadly defined, “aryl”, as used herein, includes 5-, 6-, 7-, 8-, 9-, and 10-membered single-ring aromatic groups that may include from zero to four heteroatoms, for example, benzene, pyrrole, furan, thiophene, imidazole, oxazole, thiazole, triazole, pyrazole, pyridine, pyrazine, pyridazine and pyrimidine, and the like. Those aryl groups having heteroatoms in the ring structure may also be referred to as “aryl heterocycles” or “heteroaromatics”. The aromatic ring can be substituted at one or more ring positions with one or more substituents including, but not limited to, halogen, azide, alkyl, aralkyl, alkenyl, alkynyl, cycloalkyl, hydroxyl, alkoxyl, amino (or quaternized amino), nitro, sulfhydryl, imino, amido, phosphonate, phosphinate, carbonyl, carboxyl, silyl, ether, alkylthio, sulfonyl, sulfonamido, ketone, aldehyde, ester, heterocyclyl, aromatic or heteroaromatic moieties, —CF₃, —CN; and combinations thereof.

The term “aryl” also includes polycyclic ring systems having two or more cyclic rings in which two or more carbons are common to two adjoining rings (i.e., “fused rings”) wherein at least one of the rings is aromatic, e.g., the other cyclic ring or rings can be cycloalkyls, cycloalkenyls, cycloalkynyls, aryls and/or heterocycles. Examples of heterocyclic rings include, but are not limited to, benzimidazolyl, benzofuranyl, benzothiofuranyl, benzothiophenyl, benzoxazolyl, benzoxazolinyl, benzthiazolyl, benztriazolyl, benztetrazolyl, benzisoxazolyl, benzisothiazolyl, benzimidazolinyl, carbazolyl, 4aH carbazolyl, carbolinyl, chromanyl, chromenyl, cinnolinyl, decahydroquinolinyl, 2H,6H-1,5,2-dithiazinyl, dihydrofuro[2,3 b]tetrahydrofuran, furanyl, furazanyl, imidazolidinyl, imidazolinyl, imidazolyl, 1H-indazolyl, indolenyl, indolinyl, indolizinyl, indolyl, 3H-indolyl, isatinoyl, isobenzofuranyl, isochromanyl, isoindazolyl, isoindolinyl, isoindolyl, isoquinolinyl, isothiazolyl, isoxazolyl, methylenedioxyphenyl, morpholinyl, naphthyridinyl, octahydroisoquinolinyl, oxadiazolyl, 1,2,3-oxadiazolyl, 1,2,4-oxadiazolyl, 1,2,5-oxadiazolyl, 1,3,4-oxadiazolyl, oxazolidinyl, oxazolyl, oxindolyl, pyrimidinyl, phenanthridinyl, phenanthrolinyl, phenazinyl, phenothiazinyl, phenoxathinyl, phenoxazinyl, phthalazinyl, piperazinyl, piperidinyl, piperidonyl, 4-piperidonyl, piperonyl, pteridinyl, purinyl, pyranyl, pyrazinyl, pyrazolidinyl, pyrazolinyl, pyrazolyl, pyridazinyl, pyridooxazole, pyridoimidazole, pyridothiazole, pyridinyl, pyridyl, pyrimidinyl, pyrrolidinyl, pyrrolinyl, 2H-pyrrolyl, pyrrolyl, quinazolinyl, quinolinyl, 4H-quinolizinyl, quinoxalinyl, quinuclidinyl, tetrahydrofuranyl, tetrahydroisoquinolinyl, tetrahydroquinolinyl, tetrazolyl, 6H-1,2,5-thiadiazinyl, 1,2,3-thiadiazolyl, 1,2,4-thiadiazolyl, 1,2,5-thiadiazolyl, 1,3,4-thiadiazolyl, thianthrenyl, thiazolyl, thienyl, thienothiazolyl, thienooxazolyl, thienoimidazolyl, thiophenyl and xanthenyl. One or more of the rings can be substituted as defined above for “aryl”.

The term “aralkyl”, as used herein, refers to an alkyl group substituted with an aryl group (e.g., an aromatic or heteroaromatic group).

The term “carbocycle”, as used herein, refers to an aromatic or non-aromatic ring in which each atom of the ring is carbon.

“Heterocycle” or “heterocyclic”, as used herein, refers to a cyclic radical attached via a ring carbon or nitrogen of a monocyclic or bicyclic ring containing 3-10 ring atoms, for example, from 5-6 ring atoms, consisting of carbon and one to four heteroatoms each selected from the group consisting of non-peroxide oxygen, sulfur, and N(Y) wherein Y is absent or is H, O, (C₁-C₁₀) alkyl, phenyl or benzyl, and optionally containing 1-3 double bonds and optionally substituted with one or more substituents. Examples of heterocyclic rings include, but are not limited to, benzimidazolyl, benzofuranyl, benzothiofuranyl, benzothiophenyl, benzoxazolyl, benzoxazolinyl, benzthiazolyl, benztriazolyl, benztetrazolyl, benzisoxazolyl, benzisothiazolyl, benzimidazolinyl, carbazolyl, 4aH-carbazolyl, carbolinyl, chromanyl, chromenyl, cinnolinyl, decahydroquinolinyl, 2H,6H-1,5,2-dithiazinyl, dihydrofuro[2,3-b]tetrahydrofuran, furanyl, furazanyl, imidazolidinyl, imidazolinyl, imidazolyl, 1H-indazolyl, indolenyl, indolinyl, indolizinyl, indolyl, 3H-indolyl, isatinoyl, isobenzofuranyl, isochromanyl, isoindazolyl, isoindolinyl, isoindolyl, isoquinolinyl, isothiazolyl, isoxazolyl, methylenedioxyphenyl, morpholinyl, naphthyridinyl, octahydroisoquinolinyl, oxadiazolyl, 1,2,3-oxadiazolyl, 1,2,4-oxadiazolyl, 1,2,5-oxadiazolyl, 1,3,4-oxadiazolyl, oxazolidinyl, oxazolyl, oxepanyl, oxetanyl, oxindolyl, pyrimidinyl, phenanthridinyl, phenanthrolinyl, phenazinyl, phenothiazinyl, phenoxathinyl, phenoxazinyl, phthalazinyl, piperazinyl, piperidinyl, piperidonyl, 4-piperidonyl, piperonyl, pteridinyl, purinyl, pyranyl, pyrazinyl, pyrazolidinyl, pyrazolinyl, pyrazolyl, pyridazinyl, pyridooxazole, pyridoimidazole, pyridothiazole, pyridinyl, pyridyl, pyrimidinyl, pyrrolidinyl, pyrrolinyl, 2H-pyrrolyl, pyrrolyl, quinazolinyl, quinolinyl, 4H-quinolizinyl, quinoxalinyl, quinuclidinyl, tetrahydrofuranyl, tetrahydroisoquinolinyl, tetrahydropyranyl, tetrahydroquinolinyl, tetrazolyl, 6H-1,2,5-thiadiazinyl, 1,2,3-thiadiazolyl, 1,2,4-thiadiazolyl, 1,2,5-thiadiazolyl, 1,3,4-thiadiazolyl, thianthrenyl, thiazolyl, thienyl, thienothiazolyl, thienooxazolyl, thienoimidazolyl, thiophenyl and xanthenyl. Heterocyclic groups can optionally be substituted with one or more substituents at one or more positions as defined above for alkyl and aryl, for example, halogen, alkyl, aralkyl, alkenyl, alkynyl, cycloalkyl, hydroxyl, amino, nitro, sulfhydryl, imino, amido, phosphate, phosphonate, phosphinate, carbonyl, carboxyl, silyl, ether, alkylthio, sulfonyl, ketone, aldehyde, ester, a heterocyclyl, an aromatic or heteroaromatic moiety, —CF₃, and —CN.

The term “carbonyl” is art-recognized and includes such moieties as can be represented by the general formula:

wherein X is a bond or represents an oxygen or a sulfur, and R₁₁ represents a hydrogen, an alkyl, a cycloalkyl, an alkenyl, an cycloalkenyl, or an alkynyl, R′₁₁ represents a hydrogen, an alkyl, a cycloalkyl, an alkenyl, an cycloalkenyl, or an alkynyl. Where X is an oxygen and R₁₁ or R′₁₁ is not hydrogen, the formula represents an “ester”. Where X is an oxygen and R₁₁ is as defined above, the moiety is referred to herein as a carboxyl group, and particularly when R₁₁ is a hydrogen, the formula represents a “carboxylic acid”. Where X is an oxygen and R′₁₁ is hydrogen, the formula represents a “formate”. In general, where the oxygen atom of the above formula is replaced by sulfur, the formula represents a “thiocarbonyl” group. Where X is a sulfur and R₁₁ or R′₁₁ is not hydrogen, the formula represents a “thioester.” Where X is a sulfur and R₁₁ is hydrogen, the formula represents a “thiocarboxylic acid.” Where X is a sulfur and R′ ii is hydrogen, the formula represents a “thioformate.” On the other hand, where X is a bond, and R₁₁ is not hydrogen, the above formula represents a “ketone” group. Where X is a bond, and R₁₁ is hydrogen, the above formula represents an “aldehyde” group.

The term “monoester” as used herein refers to an analog of a dicarboxylic acid wherein one of the carboxylic acids is functionalized as an ester and the other carboxylic acid is a free carboxylic acid or salt of a carboxylic acid. Examples of monoesters include, but are not limited to, to monoesters of succinic acid, glutaric acid, adipic acid, suberic acid, sebacic acid, azelaic acid, oxalic and maleic acid.

The term “heteroatom” as used herein means an atom of any element other than carbon or hydrogen. Examples of heteroatoms are boron, nitrogen, oxygen, phosphorus, sulfur and selenium. Other useful heteroatoms include silicon and arsenic.

As used herein, the term “nitro” means —NO₂; the term “halogen” designates —F, —Cl, —Br or —I; the term “sulfhydryl” means —SH; the term “hydroxyl” means —OH; and the term “sulfonyl” means —SO₂—.

The term “substituted” as used herein, refers to all permissible substituents of the compounds described herein. In the broadest sense, the permissible substituents include acyclic and cyclic, branched and unbranched, carbocyclic and heterocyclic, aromatic and nonaromatic substituents of organic compounds. Illustrative substituents include, but are not limited to, halogens, hydroxyl groups, or any other organic groupings containing any number of carbon atoms, for example, 1-14 carbon atoms, and optionally include one or more heteroatoms such as oxygen, sulfur, or nitrogen grouping in linear, branched, or cyclic structural formats. Representative substituents include alkyl, substituted alkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, phenyl, substituted phenyl, aryl, substituted aryl, heteroaryl, substituted heteroaryl, halo, hydroxyl, alkoxy, substituted alkoxy, phenoxy, substituted phenoxy, aroxy, substituted aroxy, alkylthio, substituted alkylthio, phenylthio, substituted phenylthio, arylthio, substituted arylthio, cyano, isocyano, substituted isocyano, carbonyl, substituted carbonyl, carboxyl, substituted carboxyl, amino, substituted amino, amido, substituted amido, sulfonyl, substituted sulfonyl, sulfonic acid, phosphoryl, substituted phosphoryl, phosphonyl, substituted phosphonyl, polyaryl, substituted polyaryl, C₃-C₂₀ cyclic, substituted C₃-C₂₀ cyclic, heterocyclic, substituted heterocyclic, aminoacid, peptide, and polypeptide groups.

Heteroatoms such as nitrogen may have hydrogen substituents and/or any permissible substituents of organic compounds described herein which satisfy the valences of the heteroatoms. It is understood that “substitution” or “substituted” includes the implicit proviso that such substitution is in accordance with permitted valence of the substituted atom and the substituent, and that the substitution results in a stable compound, i.e., a compound that does not spontaneously undergo transformation, for example, by rearrangement, cyclization, or elimination.

In a broad aspect, the permissible substituents include acyclic and cyclic, branched and unbranched, carbocyclic and heterocyclic, aromatic and nonaromatic substituents of organic compounds. Illustrative substituents include, for example, those described herein. The permissible substituents can be one or more and the same or different for appropriate organic compounds. The heteroatoms such as nitrogen may have hydrogen substituents and/or any permissible substituents of organic compounds described herein which satisfy the valencies of the heteroatoms.

In various embodiments, the substituent is selected from alkoxy, aryloxy, alkyl, alkenyl, alkynyl, amide, amino, aryl, arylalkyl, carbamate, carboxy, cyano, cycloalkyl, ester, ether, formyl, halogen, haloalkyl, heteroaryl, heterocyclyl, hydroxyl, ketone, nitro, phosphate, sulfide, sulfinyl, sulfonyl, sulfonic acid, sulfonamide, and thioketone, each of which optionally is substituted with one or more suitable substituents. In some embodiments, the substituent is selected from alkoxy, aryloxy, alkyl, alkenyl, alkynyl, amide, amino, aryl, arylalkyl, carbamate, carboxy, cycloalkyl, ester, ether, formyl, haloalkyl, heteroaryl, heterocyclyl, ketone, phosphate, sulfide, sulfinyl, sulfonyl, sulfonic acid, sulfonamide, and thioketone, wherein each of the alkoxy, aryloxy, alkyl, alkenyl, alkynyl, amide, amino, aryl, arylalkyl, carbamate, carboxy, cycloalkyl, ester, ether, formyl, haloalkyl, heteroaryl, heterocyclyl, ketone, phosphate, sulfide, sulfinyl, sulfonyl, sulfonic acid, sulfonamide, and thioketone can be further substituted with one or more suitable substituents.

Examples of substituents include, but are not limited to, halogen, azide, alkyl, aralkyl, alkenyl, alkynyl, cycloalkyl, hydroxyl, alkoxyl, amino, nitro, sulfhydryl, imino, amido, phosphonate, phosphinate, carbonyl, carboxyl, silyl, ether, alkylthio, sulfonyl, sulfonamido, ketone, aldehyde, thioketone, ester, heterocyclyl, —CN, aryl, aryloxy, perhaloalkoxy, aralkoxy, heteroaryl, heteroaryloxy, heteroarylalkyl, heteroaralkoxy, azido, alkylthio, oxo, acylalkyl, carboxy esters, carboxamido, acyloxy, aminoalkyl, alkylaminoaryl, alkylaryl, alkylaminoalkyl, alkoxyaryl, arylamino, aralkylamino, alkyl sulfonyl, carboxamidoalkylaryl, carboxamidoaryl, hydroxyalkyl, haloalkyl, alkylaminoalkylcarboxy, aminocarboxamidoalkyl, cyano, alkoxyalkyl, perhaloalkyl, arylalkyloxyalkyl, and the like. In some embodiments, the substituent is selected from cyano, halogen, hydroxyl, and nitro.

The term “copolymer” as used herein, generally refers to a single polymeric material that is comprised of two or more different monomers. The copolymer can be of any form, for example, random, block, or graft. The copolymers can have any end-group, including capped or acid end groups.

The term “mean particle size”, as used herein, generally refers to the statistical mean particle size (diameter) of the particles in the composition. The diameter of an essentially spherical particle may be referred to as the physical or hydrodynamic diameter. The diameter of a non-spherical particle may refer to the hydrodynamic diameter. As used herein, the diameter of a non-spherical particle may refer to the largest linear distance between two points on the surface of the particle. Mean particle size can be measured using methods known in the art such as dynamic light scattering. Two populations can be said to have a “substantially equivalent mean particle size” when the statistical mean particle size of the first population of particles is within 20% of the statistical mean particle size of the second population of particles; for example, within 15%, or within 10%.

The terms “monodisperse” and “homogeneous size distribution”, as used interchangeably herein, describe a population of particles, microparticles, or nanoparticles all having the same or nearly the same size. As used herein, a monodisperse distribution refers to particle distributions in which 90% of the distribution lies within 5% of the mean particle size.

The terms “polypeptide,” “peptide” and “protein” generally refer to a polymer of amino acid residues. As used herein, the term also applies to amino acid polymers in which one or more amino acids are chemical analogs or modified derivatives of corresponding naturally-occurring amino acids or are unnatural amino acids. The term “protein”, as generally used herein, refers to a polymer of amino acids linked to each other by peptide bonds to form a polypeptide for which the chain length is sufficient to produce tertiary and/or quaternary structure. The term “protein” excludes small peptides by definition, the small peptides lacking the requisite higher-order structure necessary to be considered a protein.

The terms “nucleic acid,” “polynucleotide,” and “oligonucleotide” are used interchangeably to refer to a deoxyribonucleotide or ribonucleotide polymer, in linear or circular conformation, and in either single- or double-stranded form. These terms are not to be construed as limiting with respect to the length of a polymer. The terms can encompass known analogs of natural nucleotides, as well as nucleotides that are modified in the base, sugar and/or phosphate moieties (e.g., phosphorothioate backbones). In general and unless otherwise specified, an analog of a particular nucleotide has the same base-pairing specificity; i.e., an analog of A will base-pair with T. The term “nucleic acid” is a term of art that refers to a string of at least two base-sugar-phosphate monomeric units. Nucleotides are the monomeric units of nucleic acid polymers. The term includes deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) in the form of a messenger RNA, antisense, plasmid DNA, parts of a plasmid DNA or genetic material derived from a virus. An antisense nucleic acid is a polynucleotide that interferes with the expression of a DNA and/or RNA sequence. The term nucleic acids refers to a string of at least two base-sugar-phosphate combinations. Natural nucleic acids have a phosphate backbone. Artificial nucleic acids may contain other types of backbones, but contain the same bases as natural nucleic acids. The term also includes PNAs (peptide nucleic acids), phosphorothioates, and other variants of the phosphate backbone of native nucleic acids.

A “functional fragment” of a protein, polypeptide or nucleic acid is a protein, polypeptide or nucleic acid whose sequence is not identical to the full-length protein, polypeptide or nucleic acid, yet retains at least one function as the full-length protein, polypeptide or nucleic acid. A functional fragment can possess more, fewer, or the same number of residues as the corresponding native molecule, and/or can contain one or more amino acid or nucleotide substitutions. Methods for determining the function of a nucleic acid (e.g., coding function, ability to hybridize to another nucleic acid) are well-known in the art. Similarly, methods for determining protein function are well-known. For example, the DNA binding function of a polypeptide can be determined, for example, by filter-binding, electrophoretic mobility shift, or immunoprecipitation assays. DNA cleavage can be assayed by gel electrophoresis. The ability of a protein to interact with another protein can be determined, for example, by co-immunoprecipitation, two-hybrid assays or complementation, e.g., genetic or biochemical. See, for example, Fields et al. (1989) Nature 340:245-246; U.S. Pat. No. 5,585,245 and PCT WO 98/44350.

As used herein, the term “linker” refers to a carbon chain that can contain heteroatoms (e.g., nitrogen, oxygen, sulfur, etc.) and which may be 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15,16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 atoms long. Linkers may be substituted with various substituents including, but not limited to, hydrogen atoms, alkyl, alkenyl, alkynl, amino, alkylamino, dialkylamino, trialkylamino, hydroxyl, alkoxy, halogen, aryl, heterocyclic, aromatic heterocyclic, cyano, amide, carbamoyl, carboxylic acid, ester, thioether, alkylthioether, thiol, and ureido groups. Those of skill in the art will recognize that each of these groups may in turn be substituted. Examples of linkers include, but are not limited to, pH-sensitive linkers, protease cleavable peptide linkers, nuclease sensitive nucleic acid linkers, lipase sensitive lipid linkers, glycosidase sensitive carbohydrate linkers, hypoxia sensitive linkers, photo-cleavable linkers, heat-labile linkers, enzyme cleavable linkers (e.g., esterase cleavable linker), ultrasound-sensitive linkers, and x-ray cleavable linkers.

The term “pharmaceutically acceptable counter ion” refers to a pharmaceutically acceptable anion or cation. In various embodiments, the pharmaceutically acceptable counter ion is a pharmaceutically acceptable ion. For example, the pharmaceutically acceptable counter ion is selected from citrate, malate, acetate, oxalate, chloride, bromide, iodide, nitrate, sulfate, bisulfate, phosphate, acid phosphate, isonicotinate, acetate, lactate, salicylate, tartrate, oleate, tannate, pantothenate, bitartrate, ascorbate, succinate, maleate, gentisinate, fumarate, gluconate, glucaronate, saccharate, formate, benzoate, glutamate, methanesulfonate, ethanesulfonate, benzenesulfonate, p-toluenesulfonate and pamoate (i.e., 1,1′-methylene-bis-(2-hydroxy-3-naphthoate)). In some embodiments, the pharmaceutically acceptable counter ion is selected from chloride, bromide, iodide, nitrate, sulfate, bisulfate, phosphate, acid phosphate, citrate, malate, acetate, oxalate, acetate, and lactate. In particular embodiments, the pharmaceutically acceptable counter ion is selected from chloride, bromide, iodide, nitrate, sulfate, bisulfate, and phosphate.

The term “pharmaceutically acceptable salt(s)” refers to salts of acidic or basic groups that may be present in compounds used in the present compositions. Compounds included in the present compositions that are basic in nature are capable of forming a variety of salts with various inorganic and organic acids. The acids that may be used to prepare pharmaceutically acceptable acid addition salts of such basic compounds are those that form non-toxic acid addition salts, i.e., salts containing pharmacologically acceptable anions, including but not limited to sulfate, citrate, malate, acetate, oxalate, chloride, bromide, iodide, nitrate, sulfate, bisulfate, phosphate, acid phosphate, isonicotinate, acetate, lactate, salicylate, citrate, tartrate, oleate, tannate, pantothenate, bitartrate, ascorbate, succinate, maleate, gentisinate, fumarate, gluconate, glucaronate, saccharate, formate, benzoate, glutamate, methanesulfonate, ethanesulfonate, benzenesulfonate, p-toluenesulfonate and pamoate (i.e., 1,1′-methylene-bis-(2-hydroxy-3-naphthoate)) salts. Compounds included in the present compositions that include an amino moiety may form pharmaceutically acceptable salts with various amino acids, in addition to the acids mentioned above. Compounds included in the present compositions, that are acidic in nature are capable of forming base salts with various pharmacologically acceptable cations. Examples of such salts include alkali metal or alkaline earth metal salts and, particularly, calcium, magnesium, sodium, lithium, zinc, potassium, and iron salts.

If the compounds described herein are obtained as an acid addition salt, the free base can be obtained by basifying a solution of the acid salt. Conversely, if the product is a free base, an addition salt, particularly a pharmaceutically acceptable addition salt, may be produced by dissolving the free base in a suitable organic solvent and treating the solution with an acid, in accordance with conventional procedures for preparing acid addition salts from base compounds. Those skilled in the art will recognize various synthetic methodologies that may be used to prepare non-toxic pharmaceutically acceptable addition salts.

A pharmaceutically acceptable salt can be derived from an acid selected from 1-hydroxy-2-naphthoic acid, 2,2-dichloroacetic acid, 2-hydroxyethanesulfonic acid, 2-oxoglutaric acid, 4-acetamidobenzoic acid, 4-aminosalicylic acid, acetic acid, adipic acid, ascorbic acid, aspartic acid, benzenesulfonic acid, benzoic acid, camphoric acid, camphor-10-sulfonic acid, capric acid (decanoic acid), caproic acid (hexanoic acid), caprylic acid (octanoic acid), carbonic acid, cinnamic acid, citric acid, cyclamic acid, dodecylsulfuric acid, ethane-1,2-disulfonic acid, ethanesulfonic acid, formic acid, fumaric acid, galactaric acid, gentisic acid, glucoheptonic acid, gluconic acid, glucuronic acid, glutamic acid, glutaric acid, glycerophosphoric acid, glycolic acid, hippuric acid, hydrobromic acid, hydrochloric acid, isethionic, isobutyric acid, lactic acid, lactobionic acid, lauric acid, maleic acid, malic acid, malonic acid, mandelic acid, methanesulfonic acid, mucic, naphthalene-1,5-disulfonic acid, naphthalene-2-sulfonic acid, nicotinic acid, nitric acid, oleic acid, oxalic acid, palmitic acid, pamoic acid, pantothenic, phosphoric acid, proprionic acid, pyroglutamic acid, salicylic acid, sebacic acid, stearic acid, succinic acid, sulfuric acid, tartaric acid, thiocyanic acid, toluenesulfonic acid, trifluoroacetic, and undecylenic acid.

The term “bioavailable” is art-recognized and refers to a form of the subject invention that allows for it, or a portion of the amount administered, to be absorbed by, incorporated to, or otherwise physiologically available to a subject or patient to whom it is administered.

It will be appreciated that the following examples are intended to illustrate but not to limit the present invention. Various other examples and modifications of the foregoing description and examples will be apparent to a person skilled in the art after reading the disclosure without departing from the spirit and scope of the invention, and it is intended that all such examples or modifications be included within the scope of the appended claims. All publications and patents referenced herein are hereby incorporated by reference in their entirety.

EXAMPLES Example 1: Synthesis, HPLC Analysis and Membrane Permeation of the Conjugates

Synthesis and HPLC analysis of the compounds described herein were carried out with methods disclosed in the Examples A, 1-7, and 14 of PCT Application No. PCT/US15/38569 (WO2016/004048) filed Jun. 30, 2015, the contents of which are incorporated herein by reference.

Example 2: In Vitro Effect of Conjugate 57 on Tumor Cell Proliferation

Conjugate 57 was assessed in an in vitro assay evaluating inhibition of cell proliferation of tumor cells. A range of tumor cell lines were selected based on reported SSTR2 mRNA levels. Characterization of cell surface SSTR2 receptor expression was performed by Western staining assay. Levels of Western staining ranged from Very strong to Weak or No staining.

TABLE 5A Conjugate 57-treated Cell Proliferation IC₅₀ SSTR2 Protein Proliferation Cell Tumor SSTR2 Level (semi- IC₅₀ line Type mRNA quantitative) (mM) IMR32 Brain 11.69 Very Strong 0.0008 H524 SCLC 10.34 Very Strong 0.0675 H69 SCLC 8.9 Strong 0.108 HCC33 SCLC 8.18 Strong 0.372 COR-L279 SCLC 8.21 Moderate 0.899 SKNF1 Ganglia 9.2 Weak/No staining 2.289

Activity of Conjugate 57 in proliferation assays and degree of IC50 correlates with observed cell surface expression of SSTR2 by Wester staining.

Inhibition of Proliferation of SCLC Cell Lines In Vitro with Conjugate 57 and DM1

The purpose of this study was to determine the receptor-dependent inhibition of proliferation in vitro by the somatostatin targeting conjugate Conjugate 57 and determine the sensitivity to DM1 in the human SSTR2 expressing cancer cell lines: NCI-H69, NCI-H82, NCI-H727 and HCC-33. Cells were incubated with Conjugate 57 for 6 hours, in the presence or absence of an excess of octreotide, a somatostatin analogue. A three-fold serial dilution of Conjugate 57 was used for a total of ten concentration points. After treatment, cells were washed, incubated for an additional period of time, either 72 or 96 hours and proliferation was measured using the CellTiter-Glo® Luminescent Cell Viability Assay. The IC₅₀ of Conjugate 57 was used to determine the inhibiting activity in proliferation assays. To determine DM1 sensitivity a similar method to the Conjugate 57 assay was employed with the additional incubation time points of 30 minutes, 1, 2, and 4 hours and the exclusion of the pre-treatment with octreotide. DM1 effect from the most to least sensitive cell line was determined to be: NCI-H69>HCC-33>NCI-H82>NCI-H727 (Table 5B). Comparing the results amongst the cell lines, under these conditions, Conjugate 57 was most potent in NCI-H69 and NCI-H82, followed closely by HCC-33 with the least potency in NCI-H727 (Table 5C). The addition of excess octreotide (100 μM) competes with Conjugate 57 for binding to the SSTR2 receptor. A decrease in activity of Conjugate 57 in the presence of octreotide would suggest the activity of Conjugate 57 is dependent upon its binding to the receptor. In the NCI-H82 and NCI-H727 cell lines, Conjugate 57 activity was not decreased in the presence of excess octreotide; suggesting the Conjugate 57 activity in these cell lines could not overcome the high concentration of octreotide. In the NCI-H69 experiments, pre-incubation with an excess of octreotide modestly diminished the activity of Conjugate 57 by 1.6 and 2.4 fold, depending on the assay conditions. In the HCC-33 cell line, activity of Conjugate 57 was 3.2 (±1.4) times higher when dosed alone, compared to when the cells were pre-incubated with octreotide. The small but measureable changes in Conjugate 57 activity in the presence of excess octreotide seen in the NCI-H69 and HCC-33 cell lines supports the receptor dependence of the Conjugate 57 antiproliferative effect seen in vitro. In summary, although all the cell lines tested in these experiments express the SSTR2 protein, they have different levels of sensitivity to the Conjugate 57 conjugate of which the DM1 sensitivity may be a contributing factor. These data identify two variables in the sensitivity of cancer cells to Conjugate 57; sensitivity to the payload DM1 and SSTR2 binding and/or expression.

TABLE 5B Activity of DM1 in Inhibition of Proliferation Assays using Various Human Cancer Cell Lines Proliferation Inhibition IC50 of DM1 (μM) Cell Line 30 min 1 h 2 h 4 h 6 h NCI-H69 0.015 0.008 0.014 0.011 0.006 HCC-33^(a) N/A N/A N/A N/A 0.034 (n = 3) NCI-H82 0.171 0.232 0.183 0.188 0.056 NCI-H727 1.156 0.665 0.474 0.38  0.534 ^(a)N/A—Not applicable

TABLE 5C Summary of Results from the Inhibition of Proliferation of NCI- H69, NCI-H82, NCI-H727 and HCC-33 cells by Conjugate 57 In vitro Assay Conditions Inhibition of Proliferation IC₅₀ Assay Without With duration Octreotide Octreotide Cell line Cells/well (h) (μM) (μM) NCI-H69 5,000 96 0.167 0.271 5,000 72 0.108 0.258 NCI-H82 5,000 72 0.106 0.128 10,000 72 1.05 1.29 NCI-H727 5,000 72 3.24 0.81 10,000 72 2.69 1.9 HCC-33 5,000 72 0.823 2.87 5,000 72 0.23 1.2 5,000 72 0.23 0.67 5,000 72 0.658 0.83

Example 3: SSTR2 Receptor Internalization by Conjugate 57

SSTR2 receptor internalization was studied using Conjugate 57 in a highly expressing SSTR2 positive (SSTR2+) tumor xenograft: H524 MD tumor xenograft. Vehicle (0.1% Solutol/5% Mannitol), Conjuate 57 at 2 mg/kg, scrambled control (BT-984) at 2 mg/kg, and Octreotide at 1.4 mg/kg (ligand alone) were given to SSTR2+H524-MD tumor xenografts (n=3/group). Timepoints—0 hr (Vehicle), 15 mins, 1 hr, 4 hr, 24 hr and 72 hrs. SSTR2 scoring was done by immunohistochemistry (IHC) staining.

FIG. 2A shows SSTR2 receptor internalization intensity. As shown in FIG. 2A, after Conjugate 57 treatment, SSTR2 receptors located on the membrance in the top left figure and became mostly cytoplasmic in the lower right figure. In this intensity of staining analysis, Conjugate 57 treatment yeiled significantly different results from scrambled peptide version of compound 57 (BT-984) and naïve at 1 hr, 4 hr, and 72 hours. Additionally, at 72 hours, Conjugate 57 treatment yielded significantly different results from Octreotide.

FIG. 2C shows levels of SSTR2 internalization distribution. In the lower right image, SSTR2 internalization reached >66%. In this distribution of staining analysis, Conjugate 57 treatment yielded significantly different results from BT-984 and naïve at 4 hr, 24 hr, and 72 hours. Additionally, at 72 hours, Conjugate 57 treatment yielded significantly different results from Octreotide.

FIG. 2B shows SSTR2 internationalization in H524-MD tumor xenografts at different times. FIG. 2D shows SSTR2 internal cellular distribution in H514-MD tumor xenografts at different times. The ‘*’ in FIG. 2B and FIG. 2D shows there was significant difference with Conjugate 57 v.s. BT-984 and naïve (*p<0.05) with Dunn's multiple comparison test. The ‘+’ in FIG. 2B and FIG. 2D shows there was significant difference with Conjugate 57 v.s. octreotide (+p<0.05) with Dunn's multiple comparison test.

Therefore, treatment of Conjugate 57 displayed significant receptor internalization/distribution supporting the hypothesis that the compound is actively targeting the receptor in vivo (unlike scrambled). Binding of the SSTR2 receptor via the octreotate ligand of Conjugate 57 induces internalization of the SSTR2 receptor and internalizes the DM-1 payload. Surprisingly, Conjugate 57 caused more SSTR2 internatilization than octreotide alone.

Example 4: Efficacy of Conjugate 57 in Treating SCLC

HCC-33 (small cell lung cancer) xenograft was chosen to study efficacy of Conjugate 57. In some groups, Conjugate 57 was given at 1.0 mg/kg, 0.5 mg/kg or 0.33 mg/kg every week for 30 days, a total of four doses for each animal. In some other groups, Conjugate 57 was also given at 0.5 mg/kg or 0.25 mg/kg twice a week for 30 dyas, a total of 8 total doses for each animal.

Study results established that multiple doses were well tolerated. Body weights in all groups were good. Tumor regression results were shown in Table 6A below and FIG. 3.

TABLE 6A TGI % of HCC-33 xenograft Conj. 57 TGI % Treatment Day 4 Day 8 Day 11 Day 15 Day 18 Day 22 Day 25 Day 29 1.0 mg/kg 25.8 69.9 84.4 93.6 97.4 99.2 99.8 99.7 0.5 mg/kg 1.6 60.3 68.8 82.7 87.1 91.1 93.6 89.5 0.33 mg/kg 2.1 34.2 48 62.4 73.8 79 83.4 78.5 0.5 mg/kg 2x/wk 0.5 61.6 78.3 91.8 96.2 97.6 99.1 99.2 0.25 mg/kg 2x/wk −12.5 50.4 67.3 85.8 92.3 95.8 97.2 97.8

A further NCI-H69 study design included Conjugate 57 dosed iv at 1.0 mg/kg formulated in propylene glycol (PG), 1.0 mg/kg formulated in Solutol HS15, 0.5 mg/kg formulated in Solutol HS15 dosed twice per week, and 0.33 mg/kg formulated in Solutol HS15 dosed three times per week. A comparator group was dosed with SOC cisplatin dosed iv at 5.0 mg/kg once per week/etoposide dosed ip at 8.0 mg/kg three times per week over two weeks. A negative control vehicle was dosed with the Solutol HS 15 vehicle. All groups contained 10 animals.

In the SOC treatment group (cisplatin and etoposide), a mean BW loss of 5.9% was observed on days 11. No weight loss was seen in the Conjugate 57 or vehicle treated animals. No adverse effects were recorded with health observations in vehicle, Conjugate 57 or SOC treated animals. However, one animal in the SOC group and one animal in the vehicle group were taken off study on Day 14 due to tumor ulcerations.

On Day 21, twice weekly treatment with 1.0 mg/kg Conjugate 57 formulated in PG resulted in 87% TGI ( 2/10 mice had complete tumor regression). With the same dose and schedule of Conjugate 57 formulated in Solutol HS15, 96% TGI was observed (3/10 mice had complete tumor regressions). TGI of 93% was observed with twice weekly dosing at 0.5 mg/kg Conjugate 57 in Solutol HS15 (1/10 mice had a complete tumor regression). Dosing Conjugate 57 three times per week at 0.33 mg/kg in Solutol HS15 resulted in 76% TGI with no mice having complete tumor regressions. A TGI of 84% was observed with cisplatin/etoposide (SOC) treatment over two weeks with no mice having complete regressions. Treatment with Conjugate 57 and SOC agents resulted in significant TGI at all dose levels and with all schedules evaluated and were not statistically different from each other. Tumor growth with all agents was significantly different from that of the vehicle control treated mice (P<0.0001). Data are summarized in Table 6B.

TABLE 6B Evaluation of Efficacy using Different Formulations and Schedules in the NCI-H69 Conjugate 57 Lung Xenograft Model Including SOC Treatment Statistical Dose Number Total significance level of doses dose MTV^(a) SEM^(b) TGT^(c) compared to Treatment (mg/kg) Formulation per week (mg/kg) (mm3) (mm3) (%) vehicle Vehicle 0 Solutol 1 0 1395 253 N/A^(d) N/A^(d) HS15 Conjugte 1.0 PG 1 2.0 178 56 87 P < 0.0001 57 Conjugte 1.0 Solutol 1 2.0 55 24 96 P < 0.0001 57 HS15 Cisplatin 5.0 Sodium 1 10.0 229 42 84 P < 0.0001 Chloride Etoposide 8.0 Sodium 3 48.0 Chloride Conjugte 0.5 Solutol 2 2.0 105 46 93 P < 0.0001 57 HS15 Conjugte 0.33 Solutol 3 2.0 330 79 76 P < 0.0001 57 HS15 ^(a)MTV—Mean Tumor Volume ^(b)SEM—Standard Error of the Mean ^(c)TGI—Tumor Growth Inhibition ^(d)N/A = Not applicable

In summary, high level, statistically significant TGI was demonstrated using Conjugate 57 with dose levels as low as once weekly 0.33 mg/kg in the HCC-33 model and there was a clear relationship (r₂=0.81) between dose and efficacy in the HCC-33 model, with increased dose level leading to increased efficacy. In the NCI-H69 model there was similar efficacy for both the PG and Solutol HS15 formulation of Conjugate 57.

Example 5: Safety Pharmacology

In Vitro Evaluation of Conjugate 57 Activity on the Human Ether-à-go-go-Related Gene (hERG) Ion Channel

The purpose of this study was to evaluate the potential of. Conjugate 57 to prolong the QT interval via modulation of the ion channel, human Ether-a-go-go Related Gene (hERG). The potential inhibition of the ion channel activity by Conjugate 57 was tested using an IonWorks Quattro electrophysiological platform, which is an automated high-throughput patch clamp system. Conjugate 57 was tested at eight different concentrations, starting at a high concentration of 10 μM and a low concentration of 0.005 μM with a minimum of five replicates for each concentration. hERG currents were evoked by a three pulse protocol where voltage was first stepped to +40 mV for two seconds from a holding potential of −80 mV to inactivate hERG channels. The voltage is then stepped back to −50 mV for two seconds to evoke a tail current prior to returning to the holding potential for 1 second. The voltage protocol was applied (Pre), compounds added, incubated for 600 seconds, and the voltage protocol was applied a final time (Post) on the IonWorks Quattro. Dimethyl sulfoxide (DMSO) was used as a negative control and Cisapride was used as a positive control. As shown in FIG. 4, Conjugate 57 exhibited less than 20% hERG inhibition at all concentrations tested whereas Cisapride inhibited evoked currents in a dose dependent fashion.

In summary, Conjugate 57 did not inhibit the hERG ion channel in this in vitro assay. Data are shown in FIG. 4.

In Vivo Cardiovascular and Respiratory Evaluation of Intravenously Administered Conjugate 57 in the Beagle Dog

This study was conducted to evaluate the potential cardiovascular and respiratory effects of Conjugate 57 in conscious freely moving naïve male beagle dogs. The study design is summarized in Table 7A.

TABLE 7A Cardiovascular and Respiratory Study Design Dose Number of Treatment Dose Dose volume concentration male number (mg/kg) (mL/kg) (mg/mL) animals^(a b) 1 0 2.5 0 12 2 0.16 2.5 0.064 4 3 0.20 2.5 0.080 4 4 0.24 2.5 0.096 4 ^(a)Each animal was treated with volume equivalents of vehicle on Day 1 and test article at one of three dose levels on Day 5 ^(b) Body temperature, blood pressure, heart rate, ECG, and respiratory parameters were monitored continuously for at least 2 hours prior to dosing and for 24 hours post dose.

Assessments of cardiovascular and respiratory effects and general toxicity were based on mortality, clinical observations, body weight, body temperature, cardiovascular evaluations, i.e., blood pressure (systolic, diastolic, and mean arterial pressures), heart rate, the ECG (QRS duration and the RR, PR, QT, and Corrected QT [QTc] intervals), and respiratory evaluations (respiratory rate, tidal volume, and minute volume). The animals were monitored continuously for at least 2 hours prior to dosing and for 24 hours post dose.

Conjugate 57, administered as a single iv infusion over 6 minutes to male beagle dogs at dose levels of 0.16 mg/kg, 0.20 mg/kg, and 0.24 mg/kg, was generally well tolerated and did not produce any clinical observations or mortality. There were no test article-related effects on the QRS duration, ECG morphology, or tidal volume at any dose level tested. At a dose level of 0.24 mg/kg, from the time of dosing through 1.5 to 2 hours following dosing, Conjugate 57 induced statistically significant increases in, blood pressure Table 7B, heart rate, and respiratory rate with decreases (reflective of the heart rate changes) in the RR, PR, and QT intervals, as well as increases in body temperature that did not reach statistical significance. From 7 to 24 hours post dose, slight increases in respiratory rate and minute volume were observed at 0.24 mg/kg. From 2 to 17 hours post dose, non-dose-dependent increases in blood pressure were observed for all test article treatments. Decreases in the PR and QT intervals were observed beginning at 5 or 12 hours, respectively, following the 0.24 mg/kg treatment, lasting through the 24 hour monitoring period.

Given the transient nature of the immediate effects observed at 0.24 mg/kg and the relatively small magnitude of the sustained effects observed at all dose levels, these changes are not considered to be adverse; iv administration of Conjugate 57 produced no adverse effects on cardiovascular or respiratory function in male beagle dogs at doses up to and including 0.24 mg/kg.

TABLE 7B Overall Segment Mean Blood Pressure Values With Conjugate 57 Analysis Analysis Analysis Dose segment 1^(a) segment 2^(b) segment 3^(c) Systolic Blood Pressure 0 mg/kg 176.8 ± 3.3 164.3 ± 1.7 160.7 ± 1.8 0.16 mg/kg 162.8 ± 5.7 172.2 ± 2.9 169.2 ± 3.1 0.20 mg/kg 161.1 ± 5.9 165.7 ± 3.0 163.4 ± 3.2 0.24 mg/kg 182.0 ± 5.7 176.3 ± 2.9 171.1 ± 3.1 Diastolic Blood Pressure 0 mg/kg 103.8 ± 2.4  94.8 ± 0.9  92.4 ± 1.1 0.16 mg/kg 100.8 ± 4.1 102.7 ± 1.5  99.6 ± 1.9 0.20 mg/kg  99.8 ± 4.2  97.7 ± 1.5  93.8 ± 1.9 0.24 mg/kg 112.0 ± 4.1 104.1 ± 1.5  97.1 ± 1.9 Mean Arterial Blood Pressure 0 mg/kg 132.8 ± 2.8 121.3 ± 1.2 118.2 ± 1.3 0.16 mg/kg 124.0 ± 4.8 128.6 ± 2.0 125.7 ± 2.2 0.20 mg/kg 122.7 ± 4.9 122.6 ± 2.1 119.4 ± 2.2 0.24 mg/kg 138.7 ± 4.8 129.8 ± 2.0 123.5 ± 2.2 ^(a)>0 to 0.25 hours post dose ^(b)>0.25 to 6 hours post dose ^(c)>6 to 24 hours post dose

In summary, the in vitro safety pharmacology evaluation of Conjugate 57 using a hERG ion channel inhibition assay revealed no evidence of significant in vitro cardiotoxicity with Conjugate 57 at concentrations of 10 μM. This in vitro safety pharmacology evaluation of Conjugate 57 lends support to the in vivo cardiovascular and respiratory study. An in vivo cardiovascular and respiratory study of Conjugate 57 in naïve male beagle dogs resulted in non-adverse statistically significant increases in blood pressure, heart rate, and respiratory rate with decreases (reflective of the heart rate changes) in the RR, PR, and QT intervals in the first two hours post dose at the MTD. Other more modest, non-dose dependent but significant changes were noted at all doses, for the blood pressure up from 2 to 17 hours as well as decreases in the PR and QT intervals were observed beginning at 5 or 12 hours, respectively, following the MTD treatment, lasting through the monitoring period.

Example 6: Stability Study of Conjugate 57

Stability studies were carried out for Conjugate 57. The tests included in the stability protocols ensure that changes relating to appearance, strength, purity, and moisture of the drug substance are monitored through-out the shelf life of the drug substance. Endotoxins are also monitored by annual inclusion of tests for these attributes in the stability program. The results of accelerated and long-term stability studies demonstrate the chemical and physical stability of Conjugate 57 when stored for up to 3 months at the label storage condition of −20° C.±5° C. Significant degradation was observed at both 5° C.±3° and 25° C./60% Relative Humidity (RH) and as a result, after 3 months stability evaluation at these two conditions was discontinued. No significant change in purity was observed after 3 months at −20° C.±5° C.

In another stability study, the following conditions were tested: 5° C.±3° C. under nitrogen and −20° C.±5° C. under nitrogen. Nitrogen was selected to prevent oxidation and assure control atmosphere during storage.

Packaging of Conjugate 57 in the stability studies are listed in Table 8:

TABLE 8 Stability Packaging Description Lot number Packaging description Lot 1 (1096) Clear Scintillation vials, 20 mL Lot 2 (BTD01) Type III amber glass jar, 30 mL, with PTFE-lined cap Nitrogen overlay Secondary moisture-barrier bag with desiccant

Stability data of Lot 1 in different conditions are shown in Tables 9A and 9B:

TABLE 9A Stability of Lot 1 stored at −20° C. ± 5° C. Test Specification Initial 3 Month Appearance a Report result White powder White powder Moisture Content by Report result  4.3% Not tested KF (USP <921> Assay Report result 88.2% 90.9% Purity(RP-HPLC) Report result 98.0% 98.0% Impurities Report result RRT 0.22-0.23: 0.25% RRT 0.22-0.23: 0.28% RRT 0.81: ND RRT 0.81: ND RRT 0.86-0.88: 0.08% RRT 0.86-0.88: 0.09% RRT 0.88: 0.06% RRT 0.88: 0.06% RRT 0.89-0.94: 0.22% RRT 0.89-0.94: 0.20% RRT 1.10: 0.20% RRT 1.10: 0.19% RRT 1.14: 0.29% RRT 1.14: 0.32% RRT 1.20: 0.38% RRT 1.20: 0.30% RRT 1.28: 0.18% RRT 1.28: 0.17% RRT 1.67-1.77: 0.30% RRT 1.67-1.77: 0.31% RRT 1.79-1.85: <0.05% RRT 1.79-1.85: <0.05% RRT 1.81-1.92: <0.05% RRT 1.81-1.92: <0.05% RRT 1.85-1.99: <0.05% RRT 1.85-1.99: <0.05% Total Impurities Report result  1.9%  1.9%

TABLE 9B Stability of Lot 1 stored at 5° C. ± 3° C. Test Specification Initial 3 Month^(a) Appearance a Report result White powder White powder Moisture Content by Report result  4.3% Not tested KF (USP <921>) Assay Report result 88.2% 88.2% Purity(RP-HPLC) Report result 98.0% 97.4% Impurities Report result RRT 0.22-0.23: 0.25% RRT 0.22-0.23: 0.44% RRT 0.81: ND RRT 0.81: 0.05 RRT 0.86-0.88: 0.08% RRT 0.86-0.88: 0.08% RRT 0.88: 0.06% RRT 0.88: 0.07% RRT 0.89-0.94: 0.22% RRT 0.89-0.94: 0.34% RRT 1.10: 0.20% RRT 1.10: 0.19% RRT 1.14: 0.29% RRT 1.14: 0.36% RRT 1.20: 0.38% RRT 1.20: 0.31% RRT 1.28: 0.18% RRT 1.28: 0.18% RRT 1.67-1.77: 0.30% RRT 1.67-1.77: 0.48% RRT 1.79-1.85: <0.05% RRT 1.79-1.85: 0.05% RRT 1.81-1.92: <0.05% RRT 1.81-1.92: 0.06% RRT 1.85-1.99: <0.05% RRT 1.85-1.99: <0.05% Total Impurities Report result  1.9%  2.5%

Stability data of Lot 2 in different conditions are shown in Tables 10A and 10B:

TABLE 10A Stability of Lot 2 stored at 25° C. ± 2° C., 60% RH ± 5% RH Test Specification Initial 3 Month^(a) Appearance Report result White powder White powder Moisture Content by Report result  4.3% Not tested KF (USP <921>) Assay Report result 88.2% 78.7% Purity (RP-HPLC) Report result 98.0% 90.8% Impurities Report result RRT 0.22-0.23: 0.25% RRT 0.22-0.23: 1.69% RRT 0.81: ND RRT 0.89-0.94: 1.21% RRT 0.86-0.88: 0.08% RRT 1.14: 0.64% RRT 0.88: 0.06% RRT 1.28: 0.25% RRT 0.89-0.94: 0.22% RRT 1.31-1.41: 0.17% RRT 1.10: 0.20% RRT 1.74-1.77: 1.85% RRT 1.14: 0.29% RRT 1.20: 0.38% RRT 1.81-1.85: 0.40% RRT 1.28: 0.18% RRT 1.88-1.93: 0.46% RRT 1.67-1.77: 0.30% RRT 1.91-1.95: 0.15% RRT 1.79-1.85: <0.05% RRT 1.95-1.99: 0.21% RRT 1.81-1.92: <0.05% Multiple additional small RRT 1.85-1.99: <0.05% peaks^(a) Total Impurities Report result  1.9%  9.2% ^(a)For ease of review, only known degradants and growing or new peaks larger than 0.15% are shown. KF: Karl Fischer titration; RP-HPLC: reversed-phase-high-performance liquid chromatography; RTT: relative retention time; USP: United States Pharmacopeia

TABLE 10B Stability of Lot 2 stored at 5° C. ± 3° C./Ambient RH under nitrogen Test Specification Initial 1 Month Appearance Report result White powder White powder Moisture Content by Report result  2.1%  1.9% KF (USP <921>) Assay — 97.0% 94.6% Purity (RP-HPLC) Report result 98.0% 96.6% Starting Materials Report  0.05%^(a) 0.05%^(a) BT-976 NMT 0.10% ND^(a) 0.09%^(a) DM1 Impurities Report results RRT 0.22: 0.05% RRT 0.20: 0.09% RRT 0.89: 0.05% RRT 0.85: 0.09% RRT 1.10: 0.11% RRT 1.10: 0.18% RRT 1.14: 0.30% RRT 1.13: 0.09% RRT 1.19: 0.29% RRT 1.14: 0.24% RRT 1.28: 0.06% RRT 1.19: 0.27% RRT 1.31: 0.15% RRT 1.20: 0.06% RRT 1.44: 0.06% RRT 1.31: 0.41% RRT 1.61: 0.06% RRT 1.43: 0.11% RRT 1.66: 0.06% RRT 1.46: 0.10% RRT 1.69: 0.29% RRT 1.47: 0.74% RRT 1.70: 0.44% RRT 1.48: 0.94% Total impurities NMT 3.0%  2.0%  3.4% Bacterial Endotoxin NMT 0.3 EU/mg <0.080 EU/mg No test ^(a)Preliminary identification based on marker retention time.

It has been shown that Conjugate 57 is stable for at least 3 months at −20° C.

Example 7: Formulation Development for Conjugate 57

Conjugate 57 is a free flowing powder. The formulation development of Conjugate 57 was accomplished by screening conditions that would provide stability and tonicity to the drug product solution. The stability of Conjugate 57 was found to be dependent on the pH of the solution (target range: 4.0 to 4.8). After screening various buffers including citrate and phosphate buffers, acetate buffer was found to provide the most stability to Conjugate 57 at a pH range of 4.0 to 4.8. The buffer is formed by a combination of sodium acetate and acetic acid. In summary, acetate buffer, a commonly used parenteral buffer, is used to dissolve Conjugate 57 and ensure stability at a pH range of 4.0 to 4.8.

Two impurities present in Conjugate 57 with RRT at 1.69 and 1.70, referred to herein as Impurity A and B respectively, were identified as Conjugate 57 adducts. Investigation into these compounds showed that they convert back into Conjugate 57 in acidic acetate buffer over a period of time. The rate of conversion of these two compounds back into Conjugate 57 is dependent on temperature. Data are provided in Table 11A and Table 11B showing this conversion at room temperature and 40° C. The total sum of Conjugate 57 and impurities A and B remained constant to within ±0.1%, which demonstrates that this treatment efficiently converts both impurities A and B back into Conjugate 57.

TABLE 11A Conversion of impurities back into Conjugate 57 in acetate buffer at room temperature. Conjugate Impurity Impurity Total Time (hr) 57 (%) A (%) B (%) (%) 0 94.6 1.17 1.29 98.6 9.0 97.8 0.23 0.66 98.7 11.6 98.1 0.15 0.54 98.8 14.8 98.3 0.11 0.44 98.8 16.7 98.3 0.09 0.39 98.8

TABLE 11B Conversion of impurities back into Conjugate 57 in acetate buffer at 40° C. Conjugate Impurity Impurity Total Time (hr) 57 (%) A (%) B (%) (%) 0 94.6 1.17 1.29 98.6 1.4 97.9 0.21 0.58 98.7 8.4 98.5 0.09 0.14 98.8

Conjugate 57 is an amphiphilic molecule and therefore tends to self-assemble into large structures. Excipient solubility and compatibility testing showed that it is not soluble in saline (solubility less than 1 mg/ml) and is not compatible with tocophersolan (TPGS), super refined PEG 300, PEG 400, ethanol, dextrose, or Pluronics F68. Commonly used parenteral surfactant excipients such as Polysorbate 80 (Tween 80) and Polyoxyl 15 Hydroxystearate (solutol, Kolliphor HS 15) were evaluated to re-assemble and stabilize Conjugate 57 into organized micelles. Conjugate 57 is compatible with non-ionic surfactants such as Tween 80 and solutol.

Filtration and freeze/thaw stability studies were carried out in the following prototype formulations (Conjugate 57 at 2.5 mg/ml): 10% Solutol/5% Mannitol/5 mM acetate buffer, pH4+; 2% Solutol/5% Mannitol/5 mM acetate buffer, pH4+; 5% Tween80/5% Mannitol/5 mM acetate buffer, pH4+; and 2% Tween80/5% Mannitol/5 mM acetate buffer, pH4+. Recovery and purity after filtration and after freeze/thaw cycles were measured. All formulation prototypes were stable after 4 freeze/thaw cycles. No loss upon sterile filtration was observed, which means aggregation was well mitigated.

Conjugate 57 frozon solution stability in prototype formualtions was also tested. Two formulation protoypes with 2 different surfactant concentrations (1% or 2%) were prepared. At room temperature, all 4 formulations are stable for at least 2 weeks. At 4° C., all 4 formulations are stable for at least 4 weeks. At −20° C., all 4 formulations are stable for at least 4 weeks. Conjugate 57 drug product is stored at −20° C. All 4 formulations are stable for at least 2 weeks in both light and dark. All 4 formulations have under gone 4 freeze/thaw cycles with little or no change in their purity.

Prototype A:

Excipient Concentration Conj. 57 (acetate salt) 2.5 mg/mL Solutol HS 15 1% or 2% (Polyoxyl 15 hydroxystearate) Mannitol 5% Acetate buffer 5 mM pH 4.0-5.0

Prototype B:

Excipient Concentration Conj. 57 (acetate salt) 2.5 mg/mL Tween 80 1% or 2% (Polysorbate 80) Mannitol 5% Acetate buffer 5 mM pH 4.0-5.0

PK Comparison in Rat Plasma

Various formulations for Conjugate 57 were tested in rat plasma. It was found that higher surfactant concentration showed better PK profile. The formulation with Solutol showed slightly better PK properties compared to Tween, as shown in FIG. 5 and the table below.

Conjugate 57 Formulations at 1.0 mg/kg Parameter Units 2% solutol 2% tween 0.25% tween C_(max) umol/L 6.67 5.27 3.48 AUC_(0-t) umol/L*h 5.42 3.53 2.88

The clinical-use stability of 2% solutol HS 15 formulation was tested in different administration kits (containers & lines). It is stable and compatible with containers and non-filtered administration sets at clinical dose.

In conclusion, Polyoxyl 15 Hydroxystearate provided great stability to Conjugate 57 and was therefore chosen as a stabilizing and solubilizing excipient. Polyoxyl 15 Hydroxystearate is a water soluble non-ionic surfactant that is typically used in the formulations of pharmaceutical drugs which are poorly water soluble or to stabilize drugs. The concentration of Polyoxyl 15 Hydroxystearate used in the Conjugate 57 solution is between 1% to 10%, between 1% to 5%, or between 2% to 5% (weight percentage). In some embodiments, the concentration of Polyoxyl 15 Hydroxystearate is about 2% (weight percentage).

In order to deliver the correct tonicity to Conjugate 57 Concentrate for Solution for Injection, a series of agents were evaluated such as mannitol, sucrose, dextrose and saline. Mannitol provided the best stability to Conjugate 57 and was therefore chosen as the tonicity agent excipient. Mannitol is used to provide the required tonicity to the infusion solution. The concentration of mannitol in the bulk filling solution is 5%.

Conjugate 57 is temperature sensitive and was therefore stored at −20° C. Conjugate 57 Concentrate for Solution for Injection vials have a labeled dose of 5 mg of Conjugate 57 per vial in 2 mL solution at a concentration of 2.5 mg/mL. Vials have a 0.15 mL overfill to ensure consistent withdrawal of the labeled 2 mL.

Example 8: Preparing a Solution for Injection Comprising Conjugate 57

Conjugate 57 was synthesized by reacting BT-976, a stable compound that is well characterized and obtained in high-chemical and stereochemical purity, with DM1, a compound that is stable, well defined, well characterized and commercially available. BT-976 is a peptide somatostatin analog similar to octreotide. It consists of natural L-amino acids with the exception of henylalanine (D-Phe¹) and tryptophan (D-Trp⁴). A disulphide bridge connects Cys² and Cys⁷. A pyridyl sulphide (PYS) group is bonded to the cysteinamide at Cys⁸. BT-976 peptide is manufactured in its acetate salt form with some residual water as a natural constituent. The amino acid sequence of BT-976 is:

The chemical structure of BT-976 is:

The coupling reaction of BT-976 and DM1 took place in a mixture of THF and water in the presence of acetic acid and sodium acetate. The reaction was stirred at temperatures around 20° C. and completed within a day. The reaction was monitored by HPLC and considered complete when BT-976 reached NMT 4% relative to the Conjugate 57 peak.

The bulk of THF was removed via chases with ethyl acetate in vacuo while keeping the bath temperature <30° C. The resulting solution was washed with ethyl acetate. Layers were separated. Conjugate 57 was in the bottom aqueous layer. The top layer (ethyl acetate layer) was extracted with 0.2 M aqueous acetic acid. Layers were separated. The bottom aqueous layer was combined to the previously described aqueous layer then acetonitrile and glacial acetic acid were added to provide Conjugate 57, as a crude solution. Conjugate 57 crude solution was then purified by reverse phase column chromatography to produce purified Conjugate 57 solution. While awaiting purification, Conjugate 57 crude solution was stored at 4° C. under inert atmosphere.

Lyophilization:

Purified Conjugate 57 solution was polish filtered to remove particulates (all subsequent solvents charges are similarly polish filtered). The resulting solution was frozen at −40 to −50° C. over the course of 3 h. The frozen solution was lyophilized with a vacuum <200 mTorr and T<5° C. for 72-82 h to produce a solid. The latter was homogenized to give lyophilized Conjugate 57. Lyophilized Conjugate 57 was tested to control residual acetonitrile (acetonitrile NMT 1,500 ppm). If this specification is not met then drying continues in vacuo at T<25° C. till acetonitrile reaches NMT 1,500 ppm. After meeting the residual acetonitrile criterion, the purity of the material was controlled by HPLC. Specifications are HPLC purity >97.0% and DM1 NMT 0.10%. Material meeting HPLC specifications was weighted to establish the overall yield. The overall yield is typically about 70% or 1 Wt relative to BT-976. The weighted material was then submitted for the next steps. Product failing purity criteria is re-purified.

Solution for Injection:

Conjugate 57 was handled under a nitrogen environment and was dissolved in an acetate buffer with a pH range of 3.7 to 4.0 to ensure control of two impurities identified in the drug substance. The impurities have been shown to be unstable in the acetate buffer and revert back into Conjugate 57. Conjugate 57 was dissolved into 40° C. acetate buffer and held for 8 to 24 hours. Then the Conjugate 57 solution was mixed with Polyoxyl 15 Hydroxystearate and mannitol. The pH of the solution was controlled to within 4.0 and 4.8 and adjusted if necessary with stock acetic acid or sodium acetate solutions. In some embodiments, the pH of the solution was controlled to be around 4.0. As a final step, additional WFI was added to the quantity sufficient (q.s.) of the target total volume.

Quality Nominal Amount, Component Standard mg/mL Function Conjugate 57 GMP 2.5 (free base) Active Polyoxyl 15 USP/EP 20 Excipient Hydroxystearate (Solutol) Mannitol USP/EP 50 Excipient Sodium Acetate USP/EP 0.066^(a) pH buffer stabilizer Acetic Acid USP/EP 0.55^(a) pH buffer stabilizer WFI USP/EP Q.S. to 100% ^(a)Quantity of sodium acetate and/or acetic acid may vary slightly from this initial value if pH adjustment is required.

The bulk solution was sterilized by filtration through two redundant 0.2 μm sterilizing grade filters. Filters were integrity tested to support sterility assurance. Vials were filled with the solution and stoppered by fully automated equipment. Vials were capped by fully automated equipment. Capped vials then underwent 100% visual inspection and were stored at −20° C. (nominal). If vial inspection does not occur immediately after capping, the vials are stored at 2-8° C.

The following controls were employed to provide assurance of product sterility: aseptic operations occur in a Class 100/Grade A area; environmental viable monitoring by settling plate and active air sampler at prespecified locations; environmental non-viable particulate monitoring at pre-specified locations; bulk solution bioburden testing immediately up-stream of sterile filtration; the bulk solution is sterilized by filtration through two redundant 0.2 μm sterilizing grade filters; sterilizing filters are integrity tested. Aseptic filling process was validated by process simulation using microbiological media (e.g. Soybean Casein Digest Medium USP).

The Conjugate 57 drug product manufacturing process was modified to include a temperature-hold treatment, where the Conjugate 57 drug substance is dissolved into 40° C. acetate buffer and held for 8 to 24 hours prior to addition of drug product excipients and being dispensed into vials.

Conjugate 57 Concentrate for Solution for Injection is a sterile product for intravenous (iv) administration. Prior to aseptic fill, the solution was passed through two redundant sterile 0.2 μm filters.

Example 9: Phase 1/Phase 2a Studies

The objectives of Phase 1 are to assess the safety and tolerability and determine the maximum tolerated dose and recommended Phase 2 dose of Conjugate 57 when administered intravenously on an every 3 week schedule in patients with somatostatin receptor 2 expressing advanced cancers (including gastroenteropancreatic or lung or thymus or other neuroendocrine tumors or small cell lung cancer or large cell neuroendocrine carcinoma of the lung). It also characterizes both acute and chronic toxicities of Conjugate 57, characterizes key pharmacokinetic parameters of Conjugate 57, DM1, and peptide from Conjugate 57, assesses the potential of Conjugate 57 to induce anti-drug antibodies, and assesses preliminary anti-tumor activity by using standard tumor response criteria (RECIST 1.1) and pharmacodynamic (PDc) biomarker changes that include chromogranin A (CgA), neuron-specific enolase (NSE), and circulating tumor cells (CTCs) in the blood, and 5-hydroxyindoleacetic acid (5-HIAA) in the urine. In addition, the study explores the relationships between tumor SSTR2 expression as measured by multiple modalities (somatostatin analog radioimaging, immunohistochemistry, CTCs, or exosome analyses) and PK, efficacy, safety, anti-Conjugate 57 antibodies, and PDc biomarker changes in the blood. Phase 1 study has two parts: Phase 1 Part A (dose escalation) and Phase 1 Part B (early expansion).

Phase 1 Part A (Dose Escalation)

Phase 1 Part A employs an adaptive Bayesian logistic regression model (BLRM) with 2 parameters guided by the escalation with overdose control (EWOC) principle to make dose recommendations and estimate the maximum tolerated dose (MTD).

The primary objective of Phase 1 Part A is to investigate the safety and tolerability, determine the MTD, and preliminary recommended phase 2 dose (RP2D) of Conjugate 57 when administered IV on an every 3 week schedule in patients with SSTR2 expressing advanced cancers, including gastroenteropancreatic (GEP) or lung or thymus or other neuroendocrine tumors (NETs) or small cell lung cancer (SCLC) or large cell neuroendocrine carcinoma (LCNEC) of the lung.

The secondary objectives of Phase 1 Part A are to: characterize the safety and tolerability of Conjugate 57, including both acute and chronic toxicities; characterize the PK of Conjugate 57, DM1, and peptide from Conjugate 57, when administered IV in patients with SSTR2 expressing advanced cancers, including GEP or lung or thymus or other NETs or SCLC or LCNEC of the lung; assess the potential of Conjugate 57 to induce anti-Conjugate 57 antibodies in the serum when administered IV in patients with SSTR2 expressing advanced cancers, including GEP or lung or thymus or other NETs or SCLC or LCNEC of the lung; assess preliminary anti-tumor activity of Conjugate 57 in patients with SSTR2 expressing advanced cancers, including GEP or lung or thymus other NETs or SCLC or LCNEC of the lung, using tumor response criteria as defined by RECIST 1.1, and duration of response.

The exploratory objectives of Phase 1 Part A are to assess preliminary anti-tumor activity of Conjugate 57 in patients with SSTR2 expressing advanced cancers, including GEP or lung or thymus or other NETs or SCLC or LCNEC of the lung, or patients with prostate cancer, by evaluating progression-free survival, overall survival, and PDc biomarker changes in the blood that include but are not limited to chromogranin A (CgA), neuron-specific enolase (NSE), and circulating tumor cells (CTCs) in the blood, and 5-hydroxyindoleacetic acid (5-HIAA) in the urine; and to explore the relationships between SSTR2 levels (as measured by somatostatin analog radioisotope imaging (SARI), immunohistochemistry [IHC], CTCs or exosomes), PK, efficacy, safety, anti-Conjugate 57 antibodies, and PDc biomarker changes in the blood.

To minimize the number of patients treated at potentially subtherapeutic dose levels, the first dose cohort enrolls 2 patients, whereas subsequent cohorts enrolls a minimum of 3 and up to 6 patients. The initial patient in Cohort 1 receives Conjugate 57 administered IV over 1 hour at the starting dose of 1.0 mg on an every 3 week cycle. This patient is followed for 7 days, including assessments during the scheduled visit on C1D8, prior to allowing additional patients to begin treatment with Conjugate 57. If Conjugate 57 is tolerated by the initial patient for at least 7 days, then the first cohort will be opened to treatment of 1 additional patient. After the first 2 patients have been assessed for safety and dose limiting toxicity (DLT) for at least 3 weeks (including C2D1 pre-dose assessments), enrollment in the second cohort may begin.

During Phase 1 Part A, if a patient is tolerating Conjugate 57 without significant evidence of disease progression, the patient may, beginning with C3, have the dose increased to a dose that has already been established as tolerable by the SRC, and with the agreement of the SRC. Dose may be increased only once for each patient.

The starting dose of Conjugate 57 is 1.0 mg. The planned dose levels are summarized in Table 12.

TABLE 12 Planned Conjugate 57 Dose Levels % Increment from Conjugate 57 Dose Dose Level Prior Dose Level (mg) −1 (50% decrease) 0.5 1 Starting dose 1 2 100%  2 3 100%  4 4 67% 6.7 5 50% 10 6 33% 13.3 7 25% 16.6 8 25% 20.8 *Actual dose increments will be the decision of the SRC but will not exceed a doubling of dose from the prior dose level. The doses assigned will be the decision of the SRC and will be guided by the updated results of BLRM.

To minimize the number of patients treated at subtherapeutic dose levels, the first dose cohort enrolls 2 patients, whereas subsequent cohorts will enroll a minimum of 3 and up to 6 patients. The initial patient receives Conjugate 57 administered IV over 1 hour at the starting dose of 1.0 mg on an every 3 week cycle. The first patient treated with Conjugate 57 in the first cohort will be observed for 7 days prior to allowing additional patients to begin treatment with Conjugate 57. If Conjugate 57 is tolerated for at least 7 days in the first patient, then the first cohort will be opened to treatment of 1 additional patient. After the first 2 patients have been assessed for safety and dose limiting toxicity (DLT) for at least 3 weeks (up until C2D1), enrollment in the second cohort may begin.

Providing there are no safety concerns after completion of the first cohort, subsequent cohorts of patients will be dosed as suitable patients are identified. However, it may be possible to choose to stagger dosing in the second cohort and likewise for subsequent cohorts.

In each dose escalation cohort following the first cohort, a minimum of 3 patients within a cohort are required to have completed C1 and have been assessed for safety and dose limiting toxicity (DLT) for at least 3 weeks (up until C2 Day 1) before enrollment of the next cohort may begin. Conjugate 57 dose cohorts are escalated sequentially after safety data collected during C1 from the patient(s) enrolled at the current dose level is enrolled.

Each patient in a dose cohort must have received Conjugate 57 in C1 and completed follow-up safety evaluations through the last day of C1 to be evaluable for the assessment of DLT. Patients who discontinue from the study for reasons other than DLT before completing C1 are to be replaced.

If a DLT necessitates enrollment of additional patients into a cohort, all safety data for that cohort after all patients have received Conjugate 57 in C1 and completed follow-up safety evaluations through the end of C1 must be review. Based on the interim evaluation of the safety and tolerability data of the previous dose level, it may also be decided that accrual will take place at an intermediate dose level.

Toxicities are graded using the National Cancer Institute (NCI) Common Terminology for Cancer Adverse Events (CTCAE), version 4.03.

Although decisions regarding dose escalation are made based on review of data from C1, safety data are also collected from all patients continuing treatment and this will be reviewed periodically by the SRC. Any detected cumulative toxicity may require later dose reductions or other action as appropriate, including further refinement of the RP2D.

Phase 1 Part B (Early Expansion)

In Phase 1 Part B, Conjugate 57 is evaluated using the preliminary recommended Phase 2 dose (RP2D) identified by the SRC.

The primary objective of Phase 1 Part B is to: confirm the MTD identified during the dose-escalation phase, and further investigate the safety and tolerability of the recommended phase 2 dose (RP2D) and schedule of Conjugate 57 when administered IV in patients with SSTR2 expressing advanced cancers, including GEP or lung or thymus other NETs or SCLC or LCNEC of the lung, or patients with prostate cancer.

The secondary objectives of Phase 1 Part B are to further characterize the PK of Conjugate 57, DM1, and peptide from Conjugate 57, in patients with SSTR2 expressing advanced cancers, including GEP or lung or thymus other NETs or SCLC or LCNEC of the lung, or patients with prostate cancer; further assess the potential of Conjugate 57 to induce anti-Conjugate 57 antibodies in the serum when administered IV in patients with SSTR2 expressing advanced cancers, including GEP or lung or thymus other NETs or SCLC or LCNEC of the lung, or patients with prostate cancer; assess preliminary anti-tumor activity of Conjugate 57 in patients with SSTR2 expressing advanced cancers, including GEP or lung or thymus other NETs or SCLC or LCNEC of the lung, or patients with prostate cancer, using tumor response criteria as defined by RECIST 1.1, and duration of response.

The exploratory objectives of Phase 1 Part B are to further assess preliminary anti-tumor activity of Conjugate 57 in patients with SSTR2 expressing advanced cancers, including GEP or lung or thymus other NETs or SCLC or LCNEC of the lung, or patients with prostate cancer, by evaluating progression-free survival, overall survival, and PDc changes that include but are not limited to CgA, NSE, CTCs in the blood, and 5-HIAA in the urine; and to further explore the relationships between SSTR2 levels (as measured by SARI, IHC, CTCs or exosomes), PK, efficacy, safety, anti-Conjugate 57 antibodies, and PDc biomarker changes in the blood.

Phase 1 Part B begins once a preliminary RP2D is identified in Phase 1 Part A of the study. The preliminary RP2D is based on the findings of the safety, tolerability, PK, and PDc profile of Conjugate 57 during Phase 1 Part A. The preliminary recommended Phase 2 dose may be the same as the MTD, or may be below the MTD. In the event that the MTD is higher than the dose determined by the SRC to have an acceptable safety and tolerability profile after multiple cycles of administration, a preliminary RP2D that is below the MTD may be selected. No more than 12 patients is treated at each dose level (including patients treated at the same dose level in Phase 1 Part B), and no more than 18 patients in total is treated in Phase 1 Part B.

Phase 2a Study

The primary objective of Phase 2a is to assess the efficacy of Conjugate 57 as a single agent using standard tumor response criteria (RECIST 1.1) as well as duration of response in 4 tumor-specific cohorts of patients with SSTR2-expressing tumors: patients with advanced, low or intermediate grade pancreatic NETs; patients with advanced, low or intermediate grade gastrointestinal or lung or thymus NETs; patients with advanced small cell lung cancer or large cell neuroendocrine carcinoma of the lung; patients with advanced paraganglioma, pheochromocytoma, medullary thyroid carcinoma, Merkel cell carcinoma, or extrapulmonary neuroendocrine carcinoma; and patients with prostate cancer. In addition, the safety, tolerability, and PK of Conjugate 57 in the above tumor specific cohorts of patients will be evaluated.

Phase 2a also explores the anti-tumor activity of Conjugate 57 in the above tumor-specific cohorts of patients by evaluating PDc biomarker changes that include chromogranin A (CgA), neuron-specific enolase (NSE), and circulating tumor cells (CTCs) in the blood, and 5-hydroxyindoleacetic acid (5-HIAA) in the urine, and explores the relationship between tumor SSTR2 expression as measured by multiple modalities (somatostatin analog radioimaging, immunohistochemistry, CTCs, and exosome analyses) and anti-tumor activity of Conjugate 57 in the above tumor-specific cohorts of patients. The relationships between SSTR2 expression, PK, efficacy, safety, anti-Conjugate 57 antibodies and PDc biomarker changes in the blood are also explored.

Phase 2a may, at the discretion of the Sponsor, begin once all patients have been enrolled in Phase 1 Part B and have been assessed for safety through and including C2D1, and the SRC has reviewed all safety data and recommends continuing with Phase 2a.

Conjugate 57 is evaluated using the RP2D as defined by the SRC at the completion of in Phase 1 Part B. A total of up to 80 patients is treated in 4 expansion cohorts, each consisting of patients with distinct subsets of SSTR2-expressing solid tumors (n=20 each) to assess the early efficacy and safety of Conjugate 57 in these distinct populations.

Schedule of events are shown in Table 13 below:

TABLE 13 Schedule of Events Treatment Period/Cycle/Day (Visit Window) Safety Follow - Prescreening Screening C2, C4, and Up Progression Evaluation/ D −180 D −14 C1 and C3 subsequent cycles EOT + Follow- Procedure to −1 to −1 D 1 D 8 D 15 D 1 D 8 D 15 EOT 28 d up Window — — — ±2 d ±2 d — ±2 d ±2 d ±3 d ±3 d ±7 d Baseline assessments Written X X informed consent Approved X SSTR tumor imaging Height X - Medical X history and demographics Cancer X diagnosis and history, including all prior systemic and radiation therapies and surgeries Review of X entrance criteria Safety Evaluations Physical examination: Complete X X X X X Neurological X X X X X Targeted X X X X (i.e., symptom- directed) Vital signs X X X X X Weight X X X X X Electrocardiogram X X X X ECOG X X X X X performance status Clinical laboratory tests: Hematology X X X X X X X X X Clinical X X X X X X X X X chemistries Estimated X X X X creatinine clearance Coagulation X X X X studies Urinalysis X X X X X Thyroid X X X X function Cholesterol X X X X and triglycerides (fasted) Peripheral X X X X blood anti- drug antibodies Pregnancy X X X X testing Disease Activity Measurements Radiographic X X X X tumor assessments Chromogranin X X X A Neuron - X X X specific enolase 5-HIAA (24 h X urine coll.) Archival X tumor sample Optional X tumor biopsy Circulating X X X tumor cells Exosome X analysis Study Drug Administration Conjugate 57 X X administration Pharmacokinetics Blood sample X collection for PK Adverse Adverse events (AEs) are to be documented from first consent through safety follow-up. events Concomitant All medications/procedures are to be documented from 30 days before first study drug medications dose on C1D1 through safety follow-up.

Prohibited Medications

The following medications and treatments are prohibited during study participation:

Concomitant use of strong CYP3A4 inhibitors (such as ketoconazole, itraconazole, clarithromycin, atazanavir, indinavir, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, and voriconazole). DM1, the cytotoxic component of Conjugate 57, is metabolized in vitro mainly by CYP3A4 and to a lesser extent by CYP3A5 [(KADCYLA® (ado-trastuzumab emtansine) package insert, Genentech, Inc., South San Francisco, Calif.]. Therefore, concomitant use of strong CYP3A4 inhibitors is prohibited due to the potential for an increase in DM1 exposure and toxicity. The use of aprepitant (EMEND®), a substrate, moderate inhibitor and inducer of CYP3A4, is NOT permitted.

Any investigational agent or device other than Conjugate 57, including agents that are commercially available for indications other than the patient's solid tumor that are under investigation for the treatment of solid tumors.

Any radiotherapy, chemotherapy, anti-neoplastic treatments or investigational agents other than study drug. Radiation for palliation at focal sites may be permitted after discussion between the Investigator and Medical Monitor.

Live virus and bacterial vaccines should not be administered, e.g., yellow fever, measles, influenza, rubella, mumps, typhoid, Mycobacterium tuberculosis (BCG), Yersinia pestis (EV). An increased risk of infection by the administration of these vaccines has been observed with conventional chemotherapy and the effects with Conjugate 57 are unknown. The administration of killed vaccines is allowed. Examples of killed vaccines are cholera, bubonic plague, polio vaccine, hepatitis A and rabies.

Other medications, other than those described above, which are considered necessary for the patient's safety and well-being, may also be given.

Medications to be Used with Caution

The following medications should be used with caution during study participation:

Anti-hyperglycemic medications: Somatostatin analogs inhibit the secretion of insulin and glucagon, which may result in hypoglycemia or hyperglycemia. Due to the similarity between somatostatin and the peptide component of Conjugate 57, dose adjustments of concomitant antihyperglycemic medications may be necessary in patients being treated with Conjugate 57.

Bradycardia-inducing drugs: Concomitant administration of bradycardia-inducing drugs (e.g., beta-blockers) may have an additive effect on the reduction of heart rate associated with somatostatin analogs. Due to the similarity between somatostatin and the peptide component of Conjugate 57, dose adjustments of concomitant bradycardia-inducing drugs may be necessary in patients being treated with Conjugate 57.

Orally administered medications: Somatostatin analogs may reduce the intestinal absorption of concomitant medications. Due to the similarity between somatostatin and the peptide component of Conjugate 57, there is a possibility that Conjugate 57 may reduce the intestinal absorption of concomitant medications.

Permitted Medications

Patients are permitted to receive appropriate supportive care measures as deemed necessary by the treating physician including but not limited to the items outlined below:

Nausea/vomiting: Anti-emetic treatment such as with 5-HT3 receptor antagonists is to be administered according to the guidelines of the study centers. Patients should be strongly encouraged to maintain liberal oral fluid intake. Strong consideration should be given to the administration of prophylactic anti-emetic therapy according to standard institutional practice, after the first cycle of Conjugate 57. The use of aprepitant (EMEND®), a substrate, moderate inhibitor and inducer of CYP3A4, is NOT permitted.

Diarrhea: Diarrhea should be treated promptly with appropriate supportive care, including administration of an anti-diarrheal agent according to standard practice guidelines. Anti-diarrheal agents should not be taken prophylactically. Patients should be instructed to begin taking anti-diarrheal medication at the first sign of: 1) poorly formed or loose stool, 2) occurrence of more bowel movements than usual in 1 day, or 3) unusually high volume of stool. Anti-diarrheal agents should be deferred if blood or mucus is present in the stool or if diarrhea is accompanied by fever. In this setting, appropriate diagnostic microbiologic specimens should be obtained to exclude an infectious etiology. Patients should also be advised to drink liberal quantities of clear fluids to help prevent dehydration.

Constipation: Constipation may be treated with stool softeners or lubricants. Use of osmotics is allowed with careful monitoring of electrolytes.

Anemia: Transfusions and/or erythropoietin may be used as clinically indicated for the treatment of anemia, but should be clearly noted as concomitant medications. Patients already receiving erythropoietin at the time of screening for the study may continue it providing they have been receiving it for more than 1 month at the time study treatment is started. Prophylactic erythropoietin should not be started during C1 of the study, but may be started during C2 and thereafter.

Neutropenia: Patients who experience Grade 4 neutropenia lasting for ≥5 days; Grade ¾ neutropenia with oral temperature ≥38.5° C.; or infection with Grade ¾ neutropenia may receive treatment with colony-stimulating factors. Prophylactic use of colony-stimulating factors including G-CSF, pegylated G-CSF or GM-CSF may be used according to institutional standards after the first cycle of Conjugate 57 therapy.

Somatostatin analogs: Agents such as octreotide, lanreotide, pasireotide, and other somatostatin analogs are permitted if their use is providing benefit in controlling carcinoid symptoms.

Somatostatin Analog Radioisotope Imaging (SARI)

Those patients who do not have documented results of a historically positive SARI obtained within 180 days of C1D1 is prescreened by SARI in this study to ensure their neuroendocrine tumors express somatostatin receptor prior to entering screening and prior to receiving Conjugate 57. This pre-screening must be performed using only SARI with regional marketing authorization to be used for detection and localization of somatostatin-receptor-positive tumors. If multiple kits with marketing authorization are available, any method may be used at the discretion of the Investigator. Patients with documentation of a historically positive SARI (by ¹¹¹In, ⁶⁸Ga, ^(99m)Tc (technetium-99m), or other radioisotope linked to a somatostatin analog) within 180 days of C1D1 to be considered positive for SSTR2 expression, and is required to receive SARI during pre-screening in this study.

Indium-Labeled SARI Octreoscan™ Kit for the Preparation of Indium In 111 Pentetreotide (pentetreotide scanning) (Mallinckrodt Nuclear Medicine LLC, Maryland Heights MO USA) comprises 2 parts: a 10 ml reaction vial and a 10 ml vial of ¹¹¹In chloride. The imaging agent is prepared within 6 h prior to use by combining the two components according to package directions to produce ¹¹¹In pentetreotide. At time of calibration, the kit contains 111 MBq/ml (3.0 mCi/ml) ¹¹¹In, with a half-life of 2.8 d.

The scan should be performed according to institutional guidelines and manufacturer instructions. FOCBP should be tested for pregnancy and excluded if pregnant. Immediately prior to use, labeling yield must be determined according to package directions. The evening prior to ¹¹¹In pentetreotide administration, a mild laxative such as bisacodyl or lactulose should be given and continued for 48 h. Both prior to and after administration, patients should be well hydrated, and should be encouraged to drink fluids liberally to reduce radiation dose by flushing out unbound agent through the kidneys as well as to ensure proper bowel cleansing. Although imaging can be performed by both planar and single-photon emission computed tomography (SPECT) cameras, only SPECT imaging should be used for scans performed in this study due to its 3-dimensional capabilities, superior sensitivity, and ability to more precisely allow tumor localization for possible comparison with computed tomography (CT) or MM scans. The recommended radiation dose for SPECT imaging is 222 MBq (6.0) mCi of pentetreotide, and the expected effective dose equivalent is 26 mSv.

Typically, imaging is performed 4 h and 24 h after administration of ¹¹¹In pentetreotide. In some cases, images taken after 48 h are also useful to aid interpretation. Investigators and designees should follow standard practice for imaging time points.

Scans are to be scored in relation to non-diseased areas of liver as listed in Table 14.

TABLE 14 Octreoscan SSTR2 Scoring Score Description 1 ¹¹¹In pentetreotide uptake lower than normal liver tissue 2 ¹¹¹In pentetreotide uptake equal to normal liver tissue 3 ¹¹¹In pentetreotide uptake greater than normal liver tissue 4 ¹¹¹In pentetreotide uptake greater than normal spleen or kidney uptake

Patients are considered to have a positive Octreoscan if their score from Table 14 is 3 or 4.

According to the manufacturer, the hormonal effect of iiiln pentetreotide is 1/10 that of octreotide. Since imaging doses are less than therapeutic doses of somatostatin analogs, the agent is not expected to exert clinically significant somatostatin effects in most cases, although severe hypoglycemia can occur in patients with insulinomas. An IV glucose solution should be administered just before and during administration in patients suspected of having an insulinoma.

In a clinical study, 83 of 87 patients (95%) who received octreotide therapy within 72 h of ¹¹¹In pentetreotide were successfully imaged. Nevertheless, imaging sensitivity may be reduced in patients concurrently receiving therapeutic doses of short-acting somatostatin therapy, so this should be considered in timing 111In pentetreotide administration.

As ¹¹¹In pentetreotide is eliminated primarily by the kidneys, use in patients with renal impairment should be considered carefully.

Adverse reactions associated with ¹¹¹In pentetreotide (<1% in clinical trials of 538 patients) included dizziness, fever, flush, headache, hypotension, changes in liver enzymes, joint pain, nausea, sweating, weakness, a single case of bradycardia, and a single case of decreased hemoglobin and hematocrit.

Gallium-Labeled SARI

SARI with ⁶⁸Ga derivatives of somatostatin analogs has been practiced since at least 2001. ⁶⁸Ga-DOTATATE (GaTate) and ⁶⁸Ga-DOTATOC are commonly used. DOTATE, also known as DOTA-TATE or DOTA-octreotate, comprises an amide of the acid DOTA, which connects a radionuclide and (Tyr3)-octreotate, a derivative of octreotide. DOTATOC, also known as edotreotide, SMT487, or (DOTA⁰-Phe¹-Tyr³)octreotide, is also an octreotide derivative which can be bound to radionuclides for diagnosis and treatment. Compared with Conjugate 57, ⁶⁸Ga-DOTATATE and ⁶⁸Ga-DOTATOC have the following affinity profiles (half-maximal inhibitory concentrations) to various human somatostatin receptors (Table 15):

TABLE 15 Affinity Profiles (Half-maximal Inhibitory Concentrations) for Various Somatostatin Analogs SSTR1 SSTR2 SSTR3 SSTR4 SSTR5 ¹¹¹In pentetreotide >10 000 22 182 >1 000 237 ⁶⁸Ga-DOTATATE >10 000 0.2 >1 000     300 377 ⁶⁸Ga-DOTATOC >10 000 2.5 613 >1 000 73 Conjugate 57    380 0.042  58 >1 000 24

⁶⁸Ga is produced from a cyclotron, or collected from a Ge—Ga generator. It is then combined with somatostatin analogs. The resulting imaging agent is administered to patients and, almost immediately thereafter, imaged using concurrent positron emission tomography (PET) and CT.

Lesions can be assigned standardized uptake values; however, a patient can be classified as positive overall using the scheme outlined in Table 14.

Pharmacokinetic Assessments

For C1D1 and C3D1, venous blood samples (4-6 ml) for determination of Conjugate 57, the somatostatin analog peptide component of Conjugate 57 (BT-979), and DM1 (total, unconjugated, and free sulfhydryl) are taken before the start of the infusion, at 0.5 hours (±1 minute) after the start of study drug infusion; precisely at the end of infusion; and 1.5 hours (±5 minutes), 2 hours (±5 minutes), 4 hours (±5 minutes), 6 hours (±5 minutes), 8 hours (±5 minutes), and 10 hours (±5 minutes) after the start of study drug infusion. If the 10 hour time point requires an inpatient admission at the center, the 10 hour time point is not collected. The date and time of collection of each sample are recorded.

Biomarker and Pharmacodynamic Assessments Rationale for Biomarker and Pharmacodynamic Assessments

Chromogranin A (CgA) is a well characterized biomarker commonly elevated in the blood of patients with NETs. It has been shown to be associated with tumor burden, prognosis, treatment response, and disease progression in patients with neuroendocrine tumors (Bajetta et al., Cancer, vol. 86:858 (1999)). It has also been shown to decrease rapidly after administration of somatostatin analogs. As such, CgA is assessed in the circulating blood of patients with NETs at baseline, and if elevated, it is followed during study treatment as a potential prognostic marker, as a potential predictor of response to treatment and disease progression, and as an exploratory biomarker of acute somatostatin pathway specific inhibition.

Neuron specific enolase (NSE) has also been found to be elevated in the blood of patients with SCLC and NETs. Although not as widely studied as CgA, elevated levels of NSE have been associated with extent of disease, prognosis and response to chemotherapy in patients with SCLC and NETs (Yao et al., J Clin Oncol., vol. 28:69 (2010)). NSE is assessed in the circulating blood of all patients at baseline, and if elevated, it will be followed during study treatment as a potential prognostic marker, and as a potential predictor of response to treatment and disease progression.

The number of circulating tumor cells (CTCs) detected in patients prior to treatment has been shown to have prognostic significance in patients with SCLC (Hou et al., J Clin Oncol., vol. 30:525 (2012)) and NETs (Khan et al., J Clin Oncol., vol. 31:365 (2013)). Additionally, SSTR2 expression on CTCs has been measured in patients with NETs. CTC number is assessed in all patients at baseline and during study treatment as a potential prognostic marker and as a potential predictor of response and disease progression. SSTR2 expression on CTCs is measured to explore the association between SSTR2 expression in CTCs and clinical activity of Conjugate 57. However, if CTCs are not detected in the C1D1 sample, the CTC sample is not collected on subsequent visits. A qualitative assessment of apoptosis is made by visual analysis of CTCs collected at baseline and during study treatment and stained with a pan-cytokeratin antibody.

Exosomes are membrane-bound phospholipid nanovesicles that are actively secreted by many types of cancer cells and that carry molecular information about the cancer, thereby having the potential to be developed as a clinical diagnostic tool without the need for a tumor biopsy. Recent technology advances have improved detection sensitivity of exosome-derived cancer related proteins (Im et al., Nat Biotechnol., vol. 32:490 (2014)). While the detection sensitivity of exosomal protein and RNA derived from patients with somatostatin receptor expressing cancers is not known, this technology holds promise as a blood based diagnostic tool for establishing somatostatin receptor expression in patients with such cancers, and could aid in the future development of Conjugate 57 and other therapies. Therefore, a blood sample is collected during screening from all patients for analysis of exosome-derived protein and/or RNA markers that include but are not limited to somatostatin receptor 2 and 5.

Chromogranin A (CgA)

Samples are not collected for CgA in SCLC or LCNEC of the lung patients. In all other patients, samples are collected for CgA on C1D1 pre-dose and 6 h post dose, as indicated in Table 13. If C1D1 values are within normal range, no further collection is done. If either or both C1D1 value(s) is above normal range, then samples continue to be collected on C2D1, and every 3rd cycle beginning on D1 of C4 (C4, C7, C10, etc.), and at EOT.

Neuron-Specific Enolase (NSE)

Samples are collected for NSE in all patients pre-dose on C1D1 as indicated in Table 13. If value at C1D1 is within normal range, no further collection is done. If value is above normal range, then samples continue to be collected from SCLC and LCNEC of the lung patients on C2D1 and then every other cycle beginning on D1 of C3 (C3, C5, C7, C9 etc.) and EOT; and continue to be collected from all other patients on C2D1 and then every 3rd cycle beginning on D1 of C4 (C4, C7, C10, etc.), and at EOT.

5-Hydroxyindoleacetic Acid (5-HIAA)

This test is not performed in SCLC or LCNEC of the lung patients. In all other patients, this test is not required. If tested, it is sampled as indicated in Table 13. Amounts of 5-HIAA will be determined by a 24-hour urine collection, beginning early in the morning on any day preceding C1D1 such that the completed 24-hour sample may be brought to the clinic for collection up until C1D1 prior to study drug dosing. If the C1D1 value is within normal range, no further 5-HIAA samples are collected. If value is above normal range, then samples continue to be collected, at the discretion of the Investigator, within the 24 hours prior to dosing on C2D1, and every 3rd cycle beginning at least 24 hours prior to dosing on D1 of C4 (C4, C7, C10, etc.), and at EOT.

Archival Tumor Sample

Whenever available, an archived formalin-fixed paraffin-embedded (FFPE) sample or samples of the patient's tumor prior to treatment with Conjugate 57 is collected for retrospective analysis of SSTR2 expression by IHC.

Optional Tumor Biopsy

A biopsy procedure is performed only for patients who sign the provision of optional tumor biopsy on the Screening informed consent form (ICF) to undergo a tumor biopsy during the Screening phase. Such patients must have at least 1 site of tumor that is accessible to biopsy and that is considered to be low risk and of sufficient size to undergo a biopsy procedure. Consent for this tumor biopsy is voluntary and optional. The procedure is performed during screening (within 14 days prior to C1D1) as indicated in Table 13, and a FFPE sample of the patient's tumor specimen will be collected for retrospective analysis of SSTR2 expression by IHC.

Circulating Tumor Cells

Whole blood samples for analysis of CTCs are taken at time points indicated in Table 13. These samples are taken pre-dose on C1D1 and on C2D1 in all patients. In SCLC and LCNEC of the lung patients, CTCs continue to be collected every other cycle beginning on D1 of C3 ((C3, C5, C7, C9, etc) and at EOT. In all other patients, CTCs continue to be collected every 3rd cycle beginning on D1 of C4 (C4, C7, C10, etc.), and at EOT. If CTCs are not detected in the C1D1 sample, they are not to be collected in subsequent visits.

Exosome Analysis

Whole blood are collected during screening as indicated in Table 13 for analyses of exosome-derived protein and/or RNA that include but are not limited to somatostatin receptor 2 and 5.

Efficacy Assessments

Tumor measurements and disease response assessments are performed for all patients. Tumor evaluation studies are performed during screening within 28 days before C1D1. For patients with SCLC or LCNEC of the lung, disease response assessments are performed within 7 days of the first study drug dose in every other cycle, starting before C3. For all other patients, disease response assessments are performed within 7 days of the first study drug dose in every 3rd cycle, starting before C4. After EOT, those patients with stable disease or an objective response or tumor not assessed is followed for disease progression. SCLC and LCNEC of the lung patients are followed approximately every 6 weeks, or as clinically indicated. Other patients are followed approximately every 9 weeks, or as clinically indicated.

For such patients, all sites of disease should be imaged by CT or MM. Subsequent assessments should use the same radiographic methods as used during screening. Anatomical measurements (summed across target lesions) are documented during screening and each subsequent evaluation. When possible, the same qualified physician interpret results to reduce variability.

Patients in Phase 1 Part A are not required to have measurable disease. Patients in Phase 1 Part B and Phase 2a are required to have measurable disease.

During screening, tumor lesions are categorized as measurable versus non-measurable and target versus non-target, as follows.

Measurable Versus Non-Measurable

Measurable: lesions that could accurately be measured in at least 1 dimension as ≥10 mm by CT scan or caliper measurement by clinical examination or ≥20 mm by chest X-ray; the longest diameter is recorded. For malignant lymph nodes, a node must be ≥15 mm in short axis by CT scan.

Non-measurable: all other lesions, including small lesions (longest diameter <10 mm or pathological lymph nodes with ≥10 to <15 mm short axis) and truly non-measurable lesions.

Target Versus Non-Target

Target: all measurable lesions up to a maximum of 2 lesions per organ and 5 lesions in total, representative of all involved organs, are identified as target lesions and measured and recorded at screening. Target lesions are selected on the basis of their size (i.e., those with the longest diameter) and suitability for accurate repeated measurement. The sum of the longest diameter for all target lesions is calculated and recorded in the eCRF as the baseline sum longest diameter.

Non-target: all other lesions not classified as target lesions (or sites of disease) are identified as non-target lesions and are recorded in the eCRF. Measurement of non-target lesions is not required.

Disease response in target and non-target lesions is assessed by the Investigator using RECIST 1.1, according to the categories and criteria described in Table 16. The best overall response for each patient is reported as the best response documented over the sequence of objective statuses recorded using the categories and criteria in Table 17.

TABLE 16 Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 Guidelines for Tumor Response Disease Response Criteria for Target and Nontarget Lesions Evaluation of Target lesions Complete Response Disappearance of all target lesions. (CR): Partial Response At least a 30% decrease in the sum of the LD of (PR): target lesions, taking as reference the baseline sum LD. Stable Disease Neither sufficient shrinkage to qualify for PR nor (SD): sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started. Progressive Disease At least a 20% increase in the sum of the LD of (PD): target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of 1 or more new lesions. Evaluation of Nontarget lesions Complete Response Disappearance of all nontarget lesions and (CR): normalization of tumor marker level. Incomplete Persistence of 1 or more nontarget lesion(s) or/and Response/Stable maintenance of tumor marker level above the Disease (SD): normal limits. Progressive Disease Appearance of 1 or more new lesions and/or (PD): unequivocal progression of existing nontarget lesions.

TABLE 17 Overall Response Criteria Patients with Target and Nontarget Lesions Target Non-Target New Overall Lesions Lesions Lesions Response CR CR No CR CR Non-CR/Non-PD No PR CR Not evaluated No PR PR Non-PD or not all evaluated No PR SD Non-PD or not all evaluated No SD Not evaluated Non-PD No NE PD Any Yes or no PD Any PD Yes or no PD Any Any Yes PD Patients with Nontarget Lesions Only Non-Target Lesions New Lesions Overall Response CR No CR Non-CR/Non-PD No Non-CR/Non-PD Not all evaluated No NE Unequivocal PD Yes or No PD Anv Yes PD CR = complete response; NE = inevaluable; PD = progressive disease.

Any patient with a PR or CR by RECIST has repeat assessments performed approximately 6 weeks later (and no sooner than 4 weeks from the prior assessment) to confirm the response. Following the confirmatory assessment, the response assessment schedule resumes at intervals of every other cycle for SCLC or LCNEC of the lung patients, and every third cycle for all other patients.

The scope of the present invention is not intended to be limited to the above Description, but rather is as set forth in the appended claims.

In the claims, articles such as “a,” “an,” and “the” may mean one or more than one unless indicated to the contrary or otherwise evident from the context. Claims or descriptions that include “or” between one or more members of a group are considered satisfied if one, more than one, or all of the group members are present in, employed in, or otherwise relevant to a given product or process unless indicated to the contrary or otherwise evident from the context. The invention includes embodiments in which exactly one member of the group is present in, employed in, or otherwise relevant to a given product or process. The invention includes embodiments in which more than one, or all of the group members are present in, employed in, or otherwise relevant to a given product or process.

It is also noted that the term “comprising” is intended to be open and permits but does not require the inclusion of additional elements or steps. When the term “comprising” is used herein, the term “consisting of” is thus also encompassed and disclosed.

Where ranges are given, endpoints are included. Furthermore, it is to be understood that unless otherwise indicated or otherwise evident from the context and understanding of one of ordinary skill in the art, values that are expressed as ranges can assume any specific value or subrange within the stated ranges in different embodiments of the invention, to the tenth of the unit of the lower limit of the range, unless the context clearly dictates otherwise.

In addition, it is to be understood that any particular embodiment of the present invention that falls within the prior art may be explicitly excluded from any one or more of the claims. Since such embodiments are deemed to be known to one of ordinary skill in the art, they may be excluded even if the exclusion is not set forth explicitly herein. Any particular embodiment of the compositions of the invention can be excluded from any one or more claims, for any reason, whether or not related to the existence of prior art.

All cited sources, for example, references, publications, databases, database entries, and art cited herein, are incorporated into this application by reference, even if not expressly stated in the citation. In case of conflicting statements of a cited source and the instant application, the statement in the instant application shall control.

Section and table headings are not intended to be limiting. 

We claim:
 1. A pharmaceutical composition comprising a conjugate and at least one excipient, wherein the conjugate comprises an active agent coupled to a somatostatin receptor (SSTR) targeting moiety by a linker, wherein the active agent is mertansine (DM1).
 2. The pharmaceutical composition of claim 1, wherein the conjugate has a structure of:


3. The pharmaceutical composition of claim 2, wherein the conjugate has a concentration of between about 2.0-about 5.0 mg/mL.
 4. The pharmaceutical composition of claim 3, wherein the conjugate has a concentration of about 2.5 mg/mL.
 5. The pharmaceutical composition of claim 2, wherein the pH of the composition is between about 4.0 to about 5.0.
 6. The pharmaceutical composition of claim 5, wherein the pH of the composition is between about 4.0 to about 4.8.
 7. The pharmaceutical composition of claim 6, wherein the pH of the composition is about 4.0.
 8. The pharmaceutical composition of claim 6, wherein the composition comprises acetate buffer.
 9. The pharmaceutical composition of claim 2, wherein the composition further comprises mannitol.
 10. The pharmaceutical composition of claim 9, wherein the mannitol has a concentration of between about 25 to about 75 mg/mL.
 11. The pharmaceutical composition of claim 10, wherein the mannitol has a concentration of about 50 mg/mL.
 12. The pharmaceutical composition of claim 2, wherein the composition further comprises polyoxyl 15 hydroxystearate.
 13. The pharmaceutical composition of claim 12, wherein the polyoxyl 15 hydroxystearate has a concentration of between about 10 to about 50 mg/mL.
 14. The pharmaceutical composition of claim 13, wherein the polyoxyl 15 hydroxystearate has a concentration of about 20 mg/mL.
 15. A method of treating tumor of a subject, comprising conducting a Somatostatin Analog Radioisotope Imaging (SARI) scanning on the subject and administering a pharmaceutical composition comprising a conjugate and at least one excipient to the subject if the SARI result is positive, wherein the conjugate comprises an active agent coupled to a somatostatin receptor (SSTR) targeting moiety by a linker, wherein the active agent is mertansine (DM1).
 16. The method of claim 15, wherein the SARI scanning comprises using a radioisotope linked to a somatostatin analog.
 17. The method of claim 16, wherein the radioisotope comprises ¹¹¹In, ⁶⁸Ga, or ^(99m)Tc.
 18. The method of claim 16, wherein the SARI scanning comprises using a ¹¹¹In pentetreotide.
 19. The method of claim 16, wherein the SARI scanning comprises using ⁶⁸Ga derivatives of somatostatin analogs.
 20. The method of claim 19, wherein the ⁶⁸Ga derivatives of somatostatin analogs comprise ⁶⁸Ga-DOTATATE or ⁶⁸Ga-DOTATOC.
 21. The method of claim 16, wherein the SARI scanning is conducted with single-photon emission computed tomography (SPECT) or concurrent positron emission tomography (PET) and Computed tomography (CT).
 22. The method of claim 19, further comprising administering at least one additional active agent.
 23. The method of claim 22, wherein the additional active agent is a drug for treating nausea, vomiting, diarrhea, constipation, anemia, neutropenia, or a somatostatin analog.
 24. The method of claim 15, wherein the tumor is a neuroendocrine tumor (NET).
 25. The method of claim 24, wherein the tumor selected from the group consisting of gastroenteropancreatic (GEP), lung, prostate, and thymus neuroendocrine tumor.
 26. The method of claim 25, wherein the tumor is small cell lung cancer (SCLC) or large cell neuroendocrine carcinoma (LCNEC) of the lung.
 27. The method of claim 15, wherein the conjugate is Conjugate
 57. 28. The method of claim 27, wherein the dosage of Conjugate 57 is at least about 0.016 mg/kg.
 29. The method of claim 27, wherein the dosage of Conjugate 57 is at least about 1 mg, 2 mg, 4 mg, 8 mg, 12 mg, 18 mg, 24 mg, 30 mg, 36 mg, 42 mg, or 48 mg.
 30. The method of claim 27, wherein the dosage of Conjugate 57 is about 25 mg. 